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Part II — Additional Tax on Distributions from

Any portion of your 2013 federal Form 8606, line 19, allocable to an amount on

any of the lines below is subject to the penalty and must be included on line 1 of

Coverdell ESAs or Qualified Tuition Programs

form FTB 3805P:

•

Your 2007-2013 FTB Pub. 1005, page 9, line 19.

(QTPs) Not Used for Educational Expenses

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Your 2000-2006 FTB Pub. 1005, page 8, line 19.

•

Your 2013 federal Form 8606, line 25 (completed using California amounts).

Line 5 – Enter the amount from federal Publication 970, Worksheet 7-3, line 16.

Line 2 – Early Distributions Not Subject to Additional Tax

Long Form 540NR Filers: Enter the taxable amount of Coverdell ESA and QTP

The additional tax does not apply to certain distributions specifically excepted by

distributions included on Schedule CA (540NR), line 15, column E.

the IRC. Enter on line 2 the amount not subject to additional tax. In the boxes on

Line 6 – Enter on line 6 the total amount that is not subject to additional tax.

line 2, enter the applicable exception number (01 – 12) from the following list.

The 2½% (.025) additional tax does not apply to distributions that are:

No. Exceptions

•

Due to the death or disability of the beneficiary.

Qualified retirement plan distributions (does not apply to IRAs) due to

•

Made on account of a scholarship, allowance, or payment described in IRC

separation from service in or after the year of reaching 55 (age 50 for

Section 25A(g)(2).

qualified public safety employees.)

•

Made because of attendance by the beneficiary at a U.S. military academy. This

Distributions made as part of a series of substantially equal periodic

exception applies only to the extent that the distribution does not exceed the

payments (made at least annually) for your life (or life expectancy) or the joint

costs of advanced education at the academy.

lives (or joint life expectancies) of you and your designated beneficiary (if

•

Included in income because you used the qualified education expenses to

from an employer plan, payments must begin after separation from service).

figure the American Opportunity Tax and Lifetime Learning credit.

Distributions due to total and permanent disability.

Line 8 – If you are not required to file Form 540 or Long Form 540NR, see General

Distributions due to death (does not apply to modified endowment contracts).

Information C, When and Where to File.

Distributions to the extent you have deductible medical expenses that can be

Part III — Additional Tax on Distributions

claimed on line 4 of federal Schedule A, Itemized Deductions, (Form 1040)

(does not apply to annuity or modified endowment contracts).

from Archer and Medicare Advantage Medical

Distributions made to an alternate payee under a qualified domestic relations

order (does not apply to IRAs).

Savings Accounts (MSAs)

Distributions made to unemployed individuals for health insurance premiums

MSA Distributions

(applies only to IRAs).

If a California taxpayer maintains an MSA, the taxpayer treats the MSA distribution

Distributions made for higher education expenses (applies only to IRAs).

as tax-free if used to pay for qualified medical expenses. If the distribution is not

Distributions made for purchase of a first home, up to $10,000 (applies only

used for qualified medical expenses, the taxpayer is subject to the additional 10%

to IRAs).

tax on this distribution. Complete federal Form 8853, before completing this part.

Distributions due to an IRS levy on the qualified retirement plan.

You need to complete line 9 and line 10 on form FTB 3805P only if you have an

Qualified distributions to reservists while serving on active duty for at least

amount on federal Form 8853, line 8.

180 days.

California does not conform to the federal law that allows a rollover from an MSA

Other exceptions (see instructions below).

to an Health Savings Account (HSA) to be treated as a tax-free distribution. If a

Other Exceptions. In addition to the exceptions listed above, the tax does not

California taxpayer rolls over his MSA into an HSA, this distribution is treated

apply to any distributions from a plan maintained by an employer if:

as an MSA distribution not used for qualified medical expenses and is subject

to California income tax and the additional 10% tax under R&TC Section 17215.

•

You separated from service by March 1, 1986.

Complete federal Form 8853, before completing this part. If you have an amount

•

As of March 1, 1986, your entire interest was in pay status under a written

election that provides a specific schedule for distribution of the entire interest.

on federal Form 8853, line 6b due to an MSA rollover to an HSA, then you must

include this amount in line 9 and complete line 10.

•

The distribution is actually being made under the written election.

Also, distributions from annuity contracts are not subject to the additional tax on

Line 9 – Enter the amount from federal Form 8853, line 8.

early distributions to the extent that the distributions are allocable to an investment

Long Form 540NR Filers: Enter the taxable amount of MSA distributions that was

in the contract before August 14, 1982.

included on Schedule CA (540NR), line 21, column E.

Distributions that are dividends paid with respect to stock described in IRC

Line 10a – Check this box if you checked the box on federal Form 8853, line 9a.

Section 404(k) are not subject to the additional tax.

Any distribution amount that is excepted from the additional tax for federal

Distributions due to an FTB notice to withhold on a qualified retirement plan are

purposes is also excepted from the additional tax for California. Refer to the

not subject to the additional tax.

instructions for federal Form 8853, line 9a.

Also enter on line 2 the amount of a distribution you received when you were age

Long Form 540NR Filers: To figure the amount of the distribution that is

59½ or older, if you received federal Form 1099-R for a distribution that incorrectly

subject to the additional 10% tax, do not include any portion of the taxable MSA

indicated an early distribution (code 1, J, or S in box 7).

[Schedule CA (540NR), line 21, column E] distributions that qualifies for an

If any of these exceptions apply, enter the distribution amount on line 2 and

exception.

exception number 12 in the boxes provided. For additional exceptions applicable to

Line 10b – If you are not required to file Form 540 or Long Form 540NR, see

annuity contracts, see IRC Section 72(q)(2) and federal Publication 575.

General Information C, When and Where to File.

Long Form 540NR Filers: Enter the portion of the taxable distribution

Medicare Advantage MSA Distributions

[Schedule CA (540NR), line 15 or line 16] that qualifies for an exception.

California law is the same as federal law regarding distributions from a Medicare

Line 3 – Subtract the amount of distributions not subject to additional tax on line 2

Advantage MSAs. Any distribution that is subject to the 50% tax under IRC

from the amount of early distributions included on line 1. Enter the result on line 3.

Section 138(c)(2) is also subject to a 50% tax for California purposes. Refer to the

This is the amount of your distribution subject to tax.

instructions for 2013 federal Form 8853, Section B, for more information.

Line 4 – Multiply line 3 by 2½% (.025). However, if any amount on line 3 was a

Line 11 – Enter the same amount you entered on your 2013 federal Form 8853,

distribution from a SIMPLE IRA received within 2 years from the date you first

line 13b.

participated in the plan, you must multiply that amount by 6% (.06) instead of

Long Form 540NR Filers: Enter 50% of the portion of the amount that you

2½% (.025). SIMPLE distributions are included in box 1 and box 2a of federal

included on line 12 of your 2013 federal Form 8853 (that does not qualify for any

Form 1099-R and are designated with a code “S” in box 7.

of the exceptions to the 50% tax) that was reported on Schedule CA (540NR),

line 21, column E.

Enter the result here and include it in the total on Form 540, line 63 or

Long Form 540NR, line 73. If you are not required to file Form 540 or

Long Form 540NR, see General Information C, When and Where to File.

FTB 3805P Instructions 2013 Page 3

Instructions For Form Ftb 3805p - Additional Taxes On Qualified Plans (Including Iras) And Other Tax-Favored Accounts - 2013 Page 3

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