Form Ftb 4803e - Head Of Household Schedule

Form Ftb 4803e - Head Of Household Schedule - 2007 Page 2

Main Reason

Code

Lived away at school

Military service

Hospital or convalescence

Birth or death

College

Code

Lived with other parent

Moved in or out

Other (please explain)

8. If your qualifying person was a foster child, was the child placed with you by an authorized placement

agency or by a judgment, decree, or other order of a court?

Yes

If yes, what is the name of the placement agency or court that ordered the placement?

_______________________________________________________________________________

9. Was your qualifying person in Question 1 married or an RDP as of December 31, 2007?

Yes

If yes, did this person file a joint federal or state tax return for 2007 with his or her spouse or RDP?

Yes

10. Was your qualifying person a citizen of the U.S. or a resident of the U.S., Canada, or Mexico?

Yes

11. As of December 31, 2007, were you single? “Single” means you never married, never registered as a

domestic partner, or were widowed (spouse or RDP died before January 1, 2007); or you were divorced,

legally separated, or your registered domestic partnership was legally terminated on or before

December 31, 2007; or your marriage or registered domestic partnership was annulled.

Yes

12. If you were legally married or an RDP during all or part of 2007, did you live with your spouse or RDP at

any time during that year? You were married or an RDP in 2007 if you were not divorced, legally

separated, or did not legally terminate your registered domestic partnership on or before December 31,

2007, and your marriage or registered domestic partnership was not annulled.

Yes

If yes, list the beginning and ending dates of each period that you lived with your spouse or RDP during

2007.

From ___________ To______________

Please provide a telephone number and the best time we can reach you between 6:30 a.m. and 7 p.m.

Monday through Friday, if we need more information.

(______) ___-____-____

Best time to call: _______________________ Telephone number:

(Area Code) (Number)

(Extension)

FTB 4803e (REV 08-2007)

Page 2

Form Ftb 4803e - Head Of Household Schedule - 2007 Page 2