Form 3532 Draft - Head Of Household Filing Status Schedule - 2017 Page 2
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1
2TAXABLE YEAR
CALIFORNIA FORM
2017
Head of Household Filing Status Schedule
3532
Attach to your California Form 540, Long or Short Form 540NR, or Form 540 2EZ.
Name(s) as shown on tax return
SSN or ITIN
Part I – Marital Status
1 Check one box below to identify your marital status. See instructions
a Not legally married/RDP during 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1a
b Widow/widower (my spouse/RDP died before 01/01/2017) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
c Marriage/RDP was annulled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
d Received final decree of divorce, legal separation, dissolution, or termination of marriage/RDP by 12/31/2017 . . . . . . . . . . . . . . .
1d
e Legally married/RDP and did not live with spouse/RDP during 2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
f Legally married/RDP and lived with spouse/RDP during 2017. List the beginning and ending dates for each period when you
1f
lived together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
From:
To:
From:
To:
Part II – Qualifying Person
2 Check one box below to identify the relationship of the person that qualifies you for the head of household filing status. See instructions.
a Son, daughter, stepson, or stepdaughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a
b Grandchild, brother, sister, half brother, half sister, stepbrother, stepsister, nephew, or niece . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2b
c Eligible foster child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2c
d Father, mother, stepfather, or stepmother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2d
e Grandfather, grandmother, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law,
2e
sister-in-law, uncle, or aunt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part III – Qualifying Person Information
3 Information about your qualifying person. See instructions.
First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DOB (MM/DD/YYYY) If your qualifying person is age 19 or older in 2017, go to line 3a. If not, go to line 4. . . . . . .
a Was your qualifying person a full time student under age 24 in 2017? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3a
Yes
No
b Was your qualifying person permanently and totally disabled in 2017? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3b
Yes
No
4 Enter qualifying person’s gross income in 2017. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Number of days your qualifying person lived with you during 2017. See instructions . . . . . . . . . . . . . . . . . . . . . . . .
When calculating the total number of days your qualifying person lived with you, you may include any days your qualifying person was temporarily
absent from your home. For example, illness, education, business, vacation, military service, and incarceration. In the event of a birth or death of
your qualifying person during the year, enter 365 days.
8481173
FTB 3532 2017
For Privacy Notice, get FTB 1131 ENG/SP.
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