California 540A Resident Income Tax Return Form
For Privacy Notice, get form FTB 1131.
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
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_____________________________________________
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
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|