Form 540nr Draft - California Nonresident Or Part-Year Resident Income Tax Return - 2016
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1
2
3TAXABLE YEAR
FORM
California Nonresident or Part-Year
540NR
2016
Resident Income Tax Return
Short Form
A
Your first name
Initial
Last name
Suffix
Your SSN or ITIN
R
If joint tax return, spouse’s/RDP’s first name
Last name
Suffix
Spouse’s/RDP’s SSN or ITIN
Initial
RP
Additional information (See instructions)
PBA code
Street address (number and street) or PO box
Apt. no./ste. no.
PMB/private mailbox
City (If you have a foreign address, see instructions)
State
ZIP code
Foreign country name
Foreign province/state/county
Foreign postal code
Your DOB (mm/dd/yyyy) ______/______/___________
Spouse’s/RDP’s DOB (mm/dd/yyyy) ______/______/___________
If you filed your 2015 tax return under a different last name, write the last name only from the 2015 tax return.
Taxpayer ______________________________________________
Spouse/RDP _____________________________________________
1
Single
4
Head of household (with qualifying person). See instructions.
2
Married/RDP filing jointly. See inst.
5
Qualifying widow(er) with dependent child. Enter year spouse/RDP died _________
If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . . . . . . . .
State of residence: Yourself__________________________ Spouse/RDP_________________________
Dates of California residency: Yourself from _____________ to ____________ Spouse/RDP from_____________ to ____________
State or country of domicile: Yourself________________________ Spouse/RDP_______________________
6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See inst . . . . . . . . . . . . . . . .
6
For line 7, line 8, and line 10: Multiply the amount you enter in the box by the pre-printed dollar amount for that line.
Whole dollars only
7 Personal: If you checked box 1 or 4 above, enter 1 in the box. If you checked box 2 or 5, enter 2 in the box.
If you checked the box on line 6, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
X $111 =
$ _________________
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1; if both are visually impaired, enter 2.
8
X $111 =
$ _________________
10 Dependents: Do not include yourself or your spouse/RDP.
Dependent 1
Dependent 2
Dependent 3
First Name
Last Name
-
-
-
-
-
-
SSN
Dependent's
relationship
to you
Total dependent exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
X $344 =
$ _________________
11 Exemption amount: Add line 7 through line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
$ _________________
00
12 Total California wages from your Form(s) W-2, box 16 . . . . . . . . . . . . . . . . . . . . . . .
12
13 Enter federal adjusted gross income from Form 1040, line 37; Form 1040A, line 21;
00
Form 1040EZ, line 4; Form 1040NR, line 36; or Form 1040NR-EZ, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
If the amount on line 13 is more than $100,000, stop here and use Long Form 540NR.
00
14 Unemployment compensation and military pay adjustment. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
00
17 Adjusted gross income from all sources. Subtract line 14 from line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
18 Standard deduction for your filing status. If you checked the box on line 6, see instructions.
• Single . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $4,129
00
• Married/RDP filing jointly, Head of household, or Qualifying widow(er) . . . . . . . . . . . . . . $8,258. . . . . . . . . . . . . . .
18
00
19 Subtract line 18 from line 17. This is your total taxable income. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . .
19
3141163
Short Form 540NR C1 2016 Side 1
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