Fillable Printable 540Nr Long Form - Franchise Tax Board
Fillable Printable 540Nr Long Form - Franchise Tax Board
540Nr Long Form - Franchise Tax Board
Long Form 540NR C1 2016 Side 1
TAXABLE YEAR
California Nonresident or Part-Year
FORM
2016
Resident Income Tax Return
540NR
Long Form
Fiscal year filers only: Enter month of year end: month
________
year 2017.
Your first name
Initial
Last name Suffix Your SSN or ITIN
If joint tax return, spouse’s/RDP’s first name
Initial
Last name Suffix Spouse’s/RDP’s SSN or ITIN
Additional information (See instructions) PBA code
Street address (number and street) or PO box Apt. no./ste. no. PMB/private mailbox
City (If you have a foreign address, see instructions) State ZIP code
Foreign country name Foreign province/state/county Foreign postal code
A
R
RP
Date of
Birth
Your DOB (mm/dd/yyyy) ______/______/___________ Spouse’s/RDP’s DOB (mm/dd/yyyy) ______/______/___________
Prior
Name
If you filed your 2015 tax return under a different last name, write the last name only from the 2015 tax return.
Taxpayer ______________________________________________ Spouse/RDP _____________________________________________
Filing
Status
1 Single 4 Head of household (with qualifying person). See instructions.
2 Married/RDP filing jointly. See inst. 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 inst ........ 6
Exemptions
First Name
Last Name
SSN
Dependent's
relationship
to you
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. If you checked the box on line 6, see instructions
............................
7
X $111 =
$ _________________
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
if both are visually impaired, enter 2
............................................
8
X $111 =
$ _________________
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2 . 9
X $111 =
$ _________________
10 Dependents: Do not include yourself or your spouse/RDP.
Dependent 1 Dependent 2 Dependent 3
Total dependent exemptions ...................................................... 10
X $344 =
$
11 Exemption amount: Add line 7 through line 10 ...................................... 11
$
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
Total Taxable Income
12 Total California wages from your Form(s) W-2, box 16 ...................... 12 00
13 Enter federal AGI from Form 1040, line 37; 1040A, line 21; 1040EZ, line 4; 1040NR, line 36;
or 1040NR-EZ, line 10
.......................................................................
13 00
14 California adjustments – subtractions. Enter the amount from Schedule CA (540NR), line 37, column B ..... 14 00
15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses. See instructions .............. 15 00
16 California adjustments – additions. Enter the amount from Schedule CA (540NR), line 37, column C........ 16 00
17 Adjusted gross income from all sources. Combine line 15 and line 16. ............................... 17 00
18 Enter the larger of: Your California itemized deductions from Schedule CA (540NR), line 44; OR
Your California standard deduction. See instructions ............................................ 18 00
19 Subtract line 18 from line 17. This is your total taxable income. If less than zero, enter -0-. ..............
19 00
3131163
- -
- -
-
Side 2 Long Form 540NR C1 2016
Your name: ______________________________________Your SSN or ITIN: ______________________________
CA Taxable Income
31 Tax. Check the box if from: Tax Table Tax Rate Schedule FTB 3800 FTB 3803 ....... 31 00
32
CA adjusted gross income from Schedule CA (540NR), Part IV, line 45..... 32 00
35
CA Taxable Income from Schedule CA (540NR), Part IV, line 49 .................................... 35 00
36
CA Tax Rate. Divide line 31 by line 19 .....................................
36 ___
.
___ ___ ___ ___
37 CA Tax Before Exemption Credits. Multiply line 35 by line 36.......................................
37 00
38 CA Exemption Credit Percentage. Divide line 35 by line 19. If more than 1, enter 1.0000
.
38 ___
.
___ ___ ___ ___
39 CA Prorated Exemption Credits. Multiply line 11 by line 38. If the amount on line 13 is more than
$182,459, see instructions.
................................................................
39 00
40
CA Regular Tax Before Credits. Subtract line 39 from line 37. If less than zero, enter -0- .................
40 00
41
Tax. See instructions. Check the box if from: Schedule G-1 FTB 5870A .................. 41 00
42
Add line 40 and line 41.................................................................... 42 00
Special Credits
50 Nonrefundable Child and Dependent Care Expenses Credit. See instructions. Attach form FTB 3506 ........ 50 00
51
Credit for joint custody head of household. See instructions. ............ 51 00
52
Credit for dependent parent. See instructions. ........................ 52 00
53
Credit for senior head of household. See instructions................... 53 00
54 Credit percentage. Enter the amount from line 38 here.
If more than 1, enter 1.0000. See instructions.
....................
54 ____ .____ ____ ____ ____
55 Credit amount. See instructions. ............................................................ 55 00
58 Enter credit name
_____________________________________ code
________ and amount........
58 00
59 Enter credit name
_____________________________________ code
________ and amount........
59 00
60 To claim more than two credits. See instructions. ............................................... 60 00
61 Nonrefundable renter’s credit. See instructions.................................................. 61 00
62 Add line 50 and line 55 through 61. These are your total credits ....................................
62 00
63 Subtract line 62 from line 42. If less than zero, enter -0- ..........................................
63 00
71 Alternative minimum tax. Attach Schedule P (540NR) ............................................ 71 00
72
Mental Health Services Tax. See instructions. .................................................. 72 00
73
Other taxes and credit recapture. See instructions. .............................................. 73 00
74
Add line 63, line 71, line 72, and line 73. This is your total tax...................................... 74 00
101 Overpaid tax. If line 86 is more than line 74, subtract line 74 from line 86 ............................
101 00
102 Amount of line 101 you want applied to your 2017 estimated tax ................................... 102 00
103 Overpaid tax available this year. Subtract line 102 from line 101.................................... 103 00
104 Tax due. If line 86 is less than line 74, subtract line 86 from line 74 .................................
104 00
Other TaxesPaymentsOverpaid
Tax/Tax Due
81 California income tax withheld. See instructions................................................. 81 00
82
2016 CA estimated tax and other payments. See instructions....................................... 82 00
83
Withholding (Form 592-B and/or 593). See instructions........................................... 83 00
84
Excess SDI (or VPDI) withheld. See instructions. ............................................... 84 00
85
Earned Income Tax Credit (EITC) ............................................................ 85 00
86 Add lines 81 through 85. These are your total payments. See instructions............................
86 00
3132163
Long Form 540NR C1 2016 (REV 03-17)
Side 3
Your name: ______________________________________Your SSN or ITIN: ______________________________
3133163
Contributions
Code Amount
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
California Seniors Special Fund. See instructions
..
......................................
Alzheimer’s Disease/Related Disorders Fund ............................................
Rare and Endangered Species Preservation Program .....................................
California Breast Cancer Research Fund ...............................................
California Firefighters’ Memorial Fund .................................................
Emergency Food for Families Fund ...................................................
California Peace Officer Memorial Foundation Fund .......................................
California Sea Otter Fund ...........................................................
California Cancer Research Fund .....................................................
RESERVED (DO NOT USE) .............................................................
School Supplies for Homeless Children Fund ...........................................
State Parks Protection Fund/Parks Pass Purchase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Protect Our Coast and Oceans Fund
..................................................
Keep Arts in Schools Fund ..........................................................
State Children’s Trust Fund for the Prevention of Child Abuse ...............................
Prevention of Animal Homelessness and Cruelty Fund ....................................
Revive the Salton Sea Fund .........................................................
California Domestic Violence Victims Fund .............................................
Special Olympics Fund .............................................................
Type 1 Diabetes Research Fund ......................................................
Add code 400 through code 435. This is your total contribution .............................
400
401
403
405
406
407
408
410
413
422
423
424
425
430
431
432
433
434
435
120120
Side 4 Long Form 540NR C1 2016
Amount
You Owe
.
,
,
00
121
AMOUNT YOU OWE. Add line 104 and line 120. See instructions. Do not send cash.
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001
......... 121
Pay Online – Go to ftb.ca.gov for more information.
Interest and
Penalties
122 Interest, late return penalties, and late payment penalties.......................................... 122 00
123
Underpayment of estimated tax. Check the box: FTB 5805 attached FTB 5805F attached . 123 00
124
Total amount due. See instructions. Enclose, but do not staple, any payment .......................... 124 00
Refund and Direct Deposit
125 REFUND OR NO AMOUNT DUE. Subtract line 120 from line 103.
Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001
.......... 125
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 125) is authorized for direct deposit into the account shown below:
Checking
Savings
Routing number Type Account number 126 Direct deposit amount
The remaining amount of my refund (line 125) is authorized for direct deposit into the account shown below:
Checking
Savings
Routing number Type Account number 127 Direct deposit amount
.
,
,
00
.
,
,
00
.
,
,
00
IMPORTANT: Attach a copy of your complete federal 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
Sign
Here
It is unlawful
to forge a
spouse’s/RDP’s
signature.
Joint tax return?
(See instructions)
Your email address. Enter only one email address. Preferred phone number
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Firm’s name (or yours, if self-employed) PTIN
Firm’s address FEIN
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
( )
( )
3134163
Your name: ______________________________________Your SSN or ITIN: ______________________________
