California Form 3504 - Enrolled Tribal Member Certification - 2016 Page 2
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22016 Instructions for Form FTB 3504
Enrolled Tribal Member Certification
General Information
Part III – Income Exemption
If you meet the exemption requirements
and do not have any other income from
Information
The instructions provided with California tax
non-reservation sources, you must complete
forms are a summary of California tax law
the entire form FTB 3504, including the
Line 4 – Exempt Income Sources
and are only intended to aid taxpayers in
signature area at the bottom, and file form
Column a - Enter the name of the exempt
preparing their state income tax returns. We
FTB 3504 as an information return at the
income source in this column.
include information that is most useful to the
address shown in General Information D,
Column b - Enter the physical address of where
greatest number of taxpayers in the limited
Where to File.
you worked, if applicable, in this column.
space available. It is not possible to include
C
When to File
Column c - Enter the exempt income type
all requirements of the California Revenue and
(wages, per capita income, etc) in this column.
Taxation Code in the instructions. Taxpayers
File form FTB 3504 for each tax year that you
should not consider the instructions as
Column d - Enter the amount that qualifies as
meet the exemption requirements. The 2016
authoritative law.
exempt income in this column.
form should be filed the following year between
January 1, 2017 and October 15, 2017.
Generally, California taxes the entire income of
Part IV – Residential Property
California residents, and the California source
D
Where to File
Information
income of nonresidents. However, if you meet
certain requirements, your income is exempt
If you are required to file Form 540 or
Line 5 – List the physical address for
from California tax.
Form 540NR, attach form FTB 3504 to the tax
each residential property(s) you own that
return and file using the address for that tax
For your income to be exempt from California
is/are located outside the boundaries of your
return.
tax, you must meet all of the following
affiliated tribe. Include the property usage, who
requirements:
resided in the property, and dates you resided
If you have no other California filing
in the property.
requirement, sign and mail form FTB 3504 to:
y You must be an enrolled member of a
federally recognized California Indian tribe.
FRANCHISE TAX BOARD
PO BOX 1998
y Go to bia.gov and search for federally
RANCHO CORDOVA, CA 95471-1998
recognized tribes.
y You must live in your tribe’s Indian country,
Specific Line Instructions
which includes:
y Reservations.
Using black or blue ink, print your name, your
y Dependent Indian communities.
social security number, and street address in
y Indian trust allotments.
the spaces provided at the top of the form.
y You must earn or receive reservation
Enter the complete physical address where
source income from the same Indian
you resided during the tax year in the spaces
Country in which you live and are an
provided. A post office box is not acceptable.
enrolled tribal member.
If you do not enter your full name, SSN, and
signature, along with complete residency
For more information about Native American
and enrollment verification in Part II, your
taxation and to locate the certification form,
certification will not be accepted.
go to ftb.ca.gov/Native-American or call the
Tribal Hotline at 916-845-2790.
Part I – Tribal Information
A
Purpose
Line 1 – Enter the name of the Indian tribe
you are an enrolled member of and your tribal
Use form FTB 3504, Enrolled Tribal Member
enrollment number provided by your tribal
Certification, to declare you reside within your
government.
tribe’s Indian country and you meet the tribal
income exemption requirements.
Line 2 – Enter the name(s) of the
reservation(s) on which you resided during the
B
Who Can File
tax year and dates of residency in the boxes
Taxpayers, who are enrolled members of a
provided.
federally recognized California Indian tribe
Part II – Residency and
earning or receiving reservation source income
Enrollment Verification
from the same Indian country in which they
live, may file form FTB 3504.
Line 3 – Enter the name and title of the tribal
File form FTB 3504 with your California
designee authorized by your tribal government.
Form 540, California Income Tax Return, or
The designee must sign, print, and date form
540NR, California Nonresident or Part-Year
FTB 3504. If this information is not completed,
Resident Income Tax Return, if you meet
your form FTB 3504 will not be accepted.
the exemption requirements and also have
Consult with your tribal government to identify
income from other non-reservation sources.
the designee with signing authority.
Follow the instructions for Schedule CA (540),
California Adjustments - Residents, and
Schedule CA (540NR) - California Adjustments -
Nonresidents and Part-Year Residents, line 7
and line 21f to make income adjustments.
FTB 3504 Instructions (NEW 2016) Page 1
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