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California Adjustments —
TAXABLE YEAR
SCHEDULE
2004
CA (540NR)
Nonresidents or Part-Year Residents
Important: Attach this schedule directly behind Long Form 540NR, Side 2.
Name(s) as shown on return
Social security number
-
-
Part I Residency Information. You must complete all lines that apply to you and your spouse.
During 2004:
Yourself
Spouse
1 a I was domiciled in (enter state) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
b I was in the military and stationed in (enter state or country) . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
2 I became a California resident (enter the state of prior residence and date of move) . . . . . . .
_____________________
_____________________
3 I became a nonresident (enter new state of residence and date of move) . . . . . . . . . . . . . . . .
_____________________
_____________________
4 I was a nonresident of California the entire year (enter state or country of residence) . . . . . .
_____________________
_____________________
5 The number of days I spent in California (for any purpose) is: . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
6 I owned a home/property in California (enter “Yes” or “No”) . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
Before 2004:
7 I was a California resident for the period of (enter dates) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
8 I entered California on (enter date) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
9 I left California on (enter date) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
_____________________
Part II Income Adjustment Schedule
A
B
C
D
E
Federal Amounts
Subtractions
Additions
Total Amounts
CA Amounts
Section A — Income
(taxable amounts from
See instructions
See instructions
Using CA Law
(income earned or
your federal return)
(difference between
(difference between
As If You Were a
received as a CA
CA & federal law)
CA & federal law)
CA Resident
resident and income
(subtract col. B from
earned or received
col. A; add col. C
from CA sources
to the result)
as a nonresident)
7 Wages, salaries, tips, etc. See instructions
before making an entry in column B or C
7
8 Taxable interest income . . . . . . . . . . . . . .
8
9 (a) Ordinary dividends. See instructions.
(b) ______________ . . . . . . . . . . . . . . . 9(a)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
10 Taxable refunds, credits, or offsets of state
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
and local income taxes. Enter the same
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
amount in column A and column B . . . . .
10
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
11 Alimony received. See instructions . . . . .
11
12 Business income or (loss) . . . . . . . . . . . .
12
13 Capital gain or (loss). See instructions. . .
13
14 Other gains or (losses) . . . . . . . . . . . . . . .
14
15 Total IRA distributions. See instructions.
(a) ______________ . . . . . . . . . . . . . . . . 15(b)
16 Total pensions and annuities. See
instructions. (a) _______________ . . . 16(b)
17 Rental real estate, royalties, partnerships,
S corporations, trusts, etc. . . . . . . . . . . . .
17
18 Farm income or (loss) . . . . . . . . . . . . . . .
18
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
19 Unemployment compensation . . . . . . . . . 19
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0
20 Social security benefits. (a)___________ 20(b)
21 Other income.
1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2
a California lottery winnings
a _____________ a _____________
1 2 3 4 5 6 7 8 9 0 1 2
{
1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2
b Disaster loss carryover from FTB 3805V
b _____________ b _____________
1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3
c Federal NOL (Form 1040, line 21)
c _____________ c _____________
1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2
d NOL carryover from FTB 3805V
21 ________________
d _____________ d _____________
21 ____________
21 ____________
1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2
e NOL from FTB 3805D, FTB 3805Z,
1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2
FTB 3806, FTB 3807, or FTB 3809
e _____________ e _____________
f Other (describe)___________________
f _____________ f _____________
________________________________
22 a Total: Combine line 7 through line 21
in each column. Continue to Side 2 . . . 22a
CANR04103
Schedule CA (540NR) 2004 Side 1