California 540A Resident Income Tax Return Form

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FORM

540A C1 Side 1

California Resident Income Tax Return 2012

Your first name Initial Last name Your SSN or ITIN

If joint tax return, spouse’s/RDP’s first name Initial Last name Spouse’s/RDP’s SSN or ITIN

Address (number and street, PO Box, or PMB no.) Apt. no/Ste. no.

City (If you have a foreign address, see page 7.) State ZIP Code

Prior Name 

If you filed your 2011 tax return under a different last name, write the last name only from the 2011 tax return.

 Taxpayer _______________________________________________  Spouse/RDP_____________________________________________

Filing 

Status 

1  Single 4  Head of household (with qualifying person) (see page 3)

2  Married/RDP filing jointly (see page 3) 5  Qualifying widow(er) with dependent child.Enter year spouse/RDP died __________

3  Married/RDP filing separately.Enter spouse’s/RDP’s SSN or ITIN above and full name here____________________________________________

If your California filing status is different from your federal filing status, check the box here  

6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here (see page 7)  6

Exemptions 

 For line 7, line 8, line 9, 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, 3, 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 page 7 7  X $104 = $________________

8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1; if both are visually impaired, enter 2 8  X $104 = $________________

9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2  9  X $104 = ▌$________________

10 Dependents: Do not include yourself or your spouse/RDP. 

First name  Last name  Dependent’s relationship to you