Form 540 - California Resident Income Tax Return - 2015 Page 5

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Your name:
Your SSN or ITIN:
111 AMOUNT YOU OWE. If you do not have an amount on line 96, add line 93, line 97, and line 110. See instructions. Do not send cash.
Mail to: FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
111
,
,
00
.
Pay online – Go to ftb.ca.gov for more information.
112 Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
.
00
00
m
m
00
113 Underpayment of estimated tax. Check the box:
FTB 5805 attached
FTB 5805F attached
113
.
114 Total amount due. See instructions. Enclose, but do not staple, any payment . . . . . . . . . . . . . . . . . . . . . . .114
00
.
115 REFUND OR NO AMOUNT DUE. Subtract the sum of line 110, line 112 and line 113 from line 96. See instructions.
Mail to: FRANCHISE TAX BOARD
PO BOX 942840
,
,
SACRAMENTO CA 94240-0001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
115
.
00
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 instructions.
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:
 Type
m
 Routing number
Checking
 Account number
116 Direct deposit amount
m
,
,
.
00
Savings
The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
 Type
m
 Routing number
Checking
 Account number
117 Direct deposit amount
m
,
,
.
00
Savings
IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov
and search for privacy notice. To request this notice by mail, call 800.852.5711. Under penalties of perjury, I declare that I have examined this tax return,
including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Your signature
Date
Spouse’s/RDP’s signature (if a joint tax return, both must sign)
X
X
Your email address (optional). Enter only one email address.
Daytime phone number (optional)
Sign
(
)
Here
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
It is unlawful
to forge a
Firm’s name (or yours, if self-employed)
PTIN
spouse’s/RDP’s
signature.
Joint tax return?
Firm’s address
FEIN
(See instructions)
m
m
 
Do you want to allow another person to discuss this tax return with us? See instructions. . . . .
Yes
No
Print Third Party Designee’s Name
Telephone Number
(
)
Form 540
2015 Side 5
3105153
C1

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