Form 3514 - California Earned Income Tax Credit - 2015 Page 2

Child 1

Child 2

Child 3

12 a. Child's physical address during

2015 (number, street, and apt .







no ./ste . no .) . See instructions . . . .







b. City . . . . . . . . . . . . . . . . . . . . . . . .







c. State . . . . . . . . . . . . . . . . . . . . . . .







d. ZIP code . . . . . . . . . . . . . . . . . . . .

Part IV California Earned Income



.

00

13 Wages, salaries, tips, and other employee compensation, subject to California withholding . See instructions . . . . .

13



.

00

14 Prison inmate wages . See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14

15 Pension or annuity from a nonqualified deferred compensation plan or a nongovernmental IRC Section 457 plan .



.

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

00



.

16 California Earned Income. Subtract line 14 and line 15 from line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16

00

Part V California Earned Income Tax Credit (Complete Step 6 in the instructions.)

17 California EITC. Enter amount from California Earned Income Tax Credit Worksheet, Part III, line 6 .

This amount should also be entered on Form 540, line 75; Form 540NR Long, Line 85; Form 540NR Short,



.

00

Line 85; or Form 540 2EZ, Line 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17

This space reserved for 2D barcode

Side 2 FTB 3514 (NEW 2015)

8462153