Form 540 Draft - California Resident Income Tax Return - 2009 Page 4
ADVERTISEMENT
1
2
3
4Your name: __________________________________ Your SSN or ITIN: ____________________________
Code
Amount
400
California Seniors Special Fund. See instructions, (see page 60) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
401
Alzheimer’s Disease/Related Disorders Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
California Fund for Senior Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
402
00
Rare and Endangered Species Preservation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
403
00
404
State Children’s Trust Fund for the Prevention of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
California Breast Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
405
00
California Firefighters’ Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
406
00
407
Emergency Food for Families Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
408
00
California Military Family Relief Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
409
00
410
California Sea Otter Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
411
California Ovarian Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
Municipal Shelter Spay-Neuter Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
412
00
California Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
413
00
414
ALS/Lou Gehrig’s Disease Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
00
110 Add code 400 through code 414. This is your total contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
110
00
111 AMOUNT YOU OWE. Add line 94, line 95, and line 110 (see page 17). Do not send cash.
00
.
,
,
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . . . . . . . .
111
Pay online – Go to ftb.ca.gov and search for web pay.
112 Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
00
113 Underpayment of estimated tax. Fill in circle:
FTB 5805 attached
FTB 5805F attached . . . . . . . . .
113
00
114 Total amount due (see page 18). Enclose, but do not staple, any payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
00
115 REFUND OR NO AMOUNT DUE. Subtract line 95 and line 110 from line 93 (see page 18).
00
.
,
,
Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002 . . . . . . . . . . .
115
Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip (see page 18).
Have you verified the routing and account numbers? Use whole dollars only.
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
Checking
00
.
,
,
Savings
Routing number
Type
Account number
116 Direct deposit amount
The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
Checking
00
.
,
,
Savings
Routing number
Type
Account number
117 Direct deposit amount
IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal return.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Your signature
Spouse’s/RDP’s signature
Daytime phone number (optional)
Sign
(if a joint return, both must sign)
)
(
Here
X
X
Date
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Paid preparer’s SSN/PTIN
It is unlawful
to forge a
spouse’s/RDP’s
Firm’s name (or yours, if self-employed)
Firm’s address
FEIN
signature.
Joint return?
(see page 19)
Do you want to allow another person to discuss this return with us (see page 19)? . . . . . . . . . . . .
Yes
No
(
)
__________________________________________________________________
__________________________________
Print Third Party Designee’s Name
Telephone Number
3103093
Form 540 C1 2009 Side 3
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