Form 100x - Amended Corporation Franchise Or Income Tax Return Page 2

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Part V Explanation of Changes
1 Enter name, address, California corporation number, and/or FEIN used on original tax return (if same as shown on this amended return, write “Same”) .
Corporation name
California corporation number
Address (suite, room, or PMB no.)
FEIN
City
State
ZIP Code
2
Explanation of changes to items in Part I, Part II, Part III, and Part IV.
Enter the line number from Side 1 for each item that is changing and give the reason for each change . Attach all supporting forms and schedules for items
changed . Include federal schedules if a change was made to the federal return . Be sure to include the corporation name and California corporation number
on each attachment . Refer to the forms and instructions for the taxable year that is being amended .
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Under penalties of perjury, I declare that I have filed an original return and I have examined this amended return, including accompanying schedules and statements, and
Sign
to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which
preparer has any knowledge.
Here
Signature of officer
Title
Date
Telephone
(
)
PTIN
Preparer’s signature
Date
Check if self-
employed
Paid
FEIN
Preparer’s
-
Use Only
Firm’s name (or yours, if
self-employed) and address
Telephone
(
)
Where to File
If the Form 100X results in a refund,
If the Form 100X results in an amount due,
If the Form 100X results in a return without
Form 100X
mail the amended tax return to:
mail the amended tax return with the check
payment or paid electronically (by EFT or Web
or money order to:
Pay), mail the amended tax return to:
FRANCHISE TAX BOARD
PO BOX 942857
FRANCHISE TAX BOARD
FRANCHISE TAX BOARD
SACRAMENTO CA 94257-0500
PO BOX 942857
PO BOX 942857
SACRAMENTO CA 94257-0501
SACRAMENTO CA 94257-0500
Side 2 Form 100X
2012
C1
3632123

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