California Form 540x - Amended Individual Income Tax Return - 2015 Page 3

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Your name:

Your SSN or ITIN:

Part II Explanation of Changes

Enter name(s) and address as shown on original return below (if same as shown on this tax return, write “Same”) . If changing from

separate tax returns to a joint tax return, enter names and addresses from original tax returns ._________________________________________________

_______________________________________________________________________________________________________________________

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Are you filing this Form 540X to report a final federal determination? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If “Yes,” attach a copy of the final federal determination and all supporting schedules and data .



Have you been advised that your original California tax return has been, is being, or will be audited? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes





Did you file an amended tax return with the Internal Revenue Service on a similar basis? See General Information E . . . . . . . . . . . .

. . .

Yes

Explanation and Attachments. Explain your changes below . If needed, attach a separate sheet that includes your name and SSN or

ITIN .

Explain in detail each change made . Include:

Attach:

•

Item being changed .

Revised California tax return including all forms and schedules .

•

Amount previously reported and corrected amount .

Federal tax return and schedules if you made changes .

•

Reason the change was needed .

Supporting documents, such as corrected W-2s, 1099s, K-1s, etc .

__________________________________________________________________________________________________________________________________

To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov

and search for privacy notice. To request this notice by mail, call 800.852.5711.

Under penalties of perjury, I declare that I have filed an original tax return and I have examined this amended tax return, including accompanying

schedules and statements, and to the best of my knowledge and belief, this amended tax return is true, correct, and complete.

Your signature

Date

Spouse’s/RDP’s signature (if a joint tax return, both must sign)

Your email address (optional). Enter only one email address.

Daytime phone number (optional)

Sign

(

)

Here

Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)

It is unlawful



to forge a

Firm’s name (or yours, if self-employed)

PTIN

spouse’s/RDP’s

signature .



Firm’s address

FEIN

Do not file a duplicate amended tax return unless one is requested . This may cause a delay in processing your amended tax return and any claim for refund .

Where to File

If you are due a refund, have no amount due, or paid electronically,

Form 540X

mail your tax return to:

FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001

If you owe, mail your return and check or money order to:

FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001

Form 540X

2015 Side 3

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