Form 110x - California Amended Corporation Franchise Or Income Tax Return Page 2

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Part IV Amount Due or Refund

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29 Amount due. If line 20 is more than line 28, subtract line 28 from line 20 . See instructions . . . . . . . . .

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30 Refund. If line 28 is more than line 20, subtract line 20 from line 28 . See instructions . . . . . . . . . . . . .

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

FEIN

Additional information

California Secretary of State file number

Street address (suite/room no.)

PMB no.

City

State

ZIP code

Foreign country name

Foreign province/state/county

Foreign postal 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 .

_______________________________________________________________________________________________________________________________

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

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Signature of officer

Title

Date

Telephone

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(

)

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PTIN