This form contains 179 fields organized into 27 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
Additional information (see instructions) Text
Provide any additional information as instructed in the form's guidelines.
Address Information
Street address (number and street) or Post Office Box Text
Enter your street address (number and street) or Post Office Box.
Apartment number or suite number Text
Enter your apartment number or suite number, if applicable.
PMB/Private Mailbox Text
Enter your PMB (Private Mailbox) number, if applicable. Maximum 6 characters.
Max length: 6 characters
City (If you have a foreign address, see instructions) Text
Enter your city. If you have a foreign address, refer to the instructions.
State. Enter two-letter abbreviation Text
Enter your state using the two-letter abbreviation.
Max length: 2 characters
Zip code. Enter first 5 digits - last 4 digits Text
Enter your zip code. It should be in the format of first 5 digits - last 4 digits. Maximum 10 characters.
Max length: 10 characters
Foreign country name Text
Enter the name of your foreign country, if applicable.
Foreign province/state/county Text
Enter the name of your foreign province, state, or county, if applicable.
Business Information
Principal Business Activity code Text
Enter the Principal Business Activity code. Maximum 6 characters.
Max length: 6 characters
Contact Information
Your email address. Enter only one email address Text
Enter your email address. Only one email address should be provided.
Preferred phone number. Enter 10 digits Text
Enter your preferred phone number. The number should be 10 digits long.
Credits
Line 50. Nonrefundable Child and Dependent Care Expenses Credit. See instructions. Attach form FTB 3506 Text
Enter the nonrefundable child and dependent care expenses credit. Refer to the instructions and attach form FTB 3506.
Max length: 12 characters
Line 51. Credit for joint custody head of household. See instructions Text
Enter the credit for joint custody head of household. Refer to the instructions.
Max length: 12 characters
Line 52. Credit for dependent parent. See instructions Text
Enter the credit for dependent parent. Refer to the instructions.
Max length: 12 characters
Line 53. Credit for senior head of household. See instructions Text
Enter the credit amount for senior head of household as per the instructions provided.
Max length: 12 characters
Line 54. Credit percentage. Enter the amount from line 38 here. If more than 1, enter 1.0000. See instructions. Enter first digit before decimal point Text
Enter the credit percentage from line 38. If the percentage is more than 1, enter 1.0000. Enter the first digit before the decimal point.
Max length: 1 characters
Line 54. Enter 4 digits after decimal point Text
Enter the four digits after the decimal point for the credit percentage.
Max length: 4 characters
Line 55. Credit amount. See instructions Text
Enter the credit amount as per the instructions provided.
Max length: 12 characters
Line 58. Enter credit name Text
Enter the name of the credit you are claiming.
Line 58. Enter credit code Text
Enter the credit code for the credit you are claiming. The code should be 3 digits long.
Max length: 3 characters
Line 58. Enter credit amount Text
Enter the amount for the credit you are claiming.
Max length: 12 characters
Line 59. Enter credit name Text
Enter the name of the second credit you are claiming.
Line 59. Enter credit code Text
Enter the credit code for the second credit you are claiming. The code should be 3 digits long.
Max length: 3 characters
Line 59. Enter credit amount Text
Enter the amount for the second credit you are claiming.
Max length: 12 characters
Line 60. To claim more than two credits. See instructions Text
If you are claiming more than two credits, see the instructions for further details.
Max length: 12 characters
Line 61. Nonrefundable Renter’s Credit. See instructions Text
Enter the amount for the Nonrefundable Renter’s Credit as per the instructions provided.
Max length: 12 characters
Line 62. Add line 50 and line 55 through 61. These are your total credits Text
Add the amounts from line 50 and lines 55 through 61. This total represents your total credits.
Max length: 12 characters
Line 85. Earned Income Tax Credit (E I T C). See instructions Text
Enter the amount of Earned Income Tax Credit (EITC) you are claiming, following the instructions.
Max length: 12 characters
Line 86. Young Child Tax Credit (Y C T C). See instructions Text
Enter the amount of Young Child Tax Credit (YCTC) you are claiming, as per the instructions.
Max length: 12 characters
Line 87. Foster Youth Tax Credit (F Y T C). See instructions Text
Enter the amount of Foster Youth Tax Credit (FYTC) you are claiming, following the instructions.
Max length: 12 characters
Deductions
Line 18. Enter the larger of: Your California itemized deductions from Schedule CA (540NR), Part Three, line 30; OR Your California standard deduction. See instructions Text
Enter the larger amount between your California itemized deductions from Schedule CA (540NR), Part Three, line 30, or your California standard deduction. Refer to the instructions for more details.
Max length: 12 characters
Dependents
Line 10. Dependents: Do not include yourself or your spouse / Registered Domestic Partner. Dependent One, first name Text
Enter the first name of your first dependent. Do not include yourself or your spouse/Registered Domestic Partner.
Dependent One, Last name Text
Enter the last name of your first dependent.
Dependent One, Social Security Number. See instructions. Enter 9 digits Text
Enter the Social Security Number of your first dependent. Ensure it is 9 digits long.
Max length: 11 characters
Dependent One, Dependent's relationship to you Text
Specify the relationship of your first dependent to you.
Dependent Two, first name Text
Enter the first name of your second dependent.
Dependent Two, Last name Text
Enter the last name of your second dependent.
Dependent Two, Social Security Number. See instructions. Enter 9 digits Text
Enter the Social Security Number of your second dependent. Ensure it is 9 digits long.
Max length: 11 characters
Dependent Two, Dependent's relationship to you Text
Specify the relationship of your second dependent to you.
Dependent Three, first name Text
Enter the first name of your third dependent.
Dependent Three, Last name Text
Enter the last name of your third dependent.
Dependent Three, Social Security Number. See instructions. Enter 9 digits Text
Enter the Social Security Number of your third dependent. Ensure it is 9 digits long.
Max length: 11 characters
Dependent Three, Dependent's relationship to you Text
Specify the relationship of your third dependent to you.
Line 10. Total number of dependent exemptions Text
Enter the total number of dependent exemptions.
Multiply the number of total dependent exemptions you put in the line 10 box by $433. Enter this number into this field. Whole dollars only Text
Multiply the total number of dependent exemptions entered in the Line 10 box by $433 and enter the result here. Use whole dollars only.
Max length: 12 characters
Direct Deposit Information
Line 126. Direct deposit amount Text
Enter the amount you wish to be directly deposited into your account.
Max length: 12 characters
Line 126. Enter the account’s routing number Text
Enter the routing number of the account where you want the direct deposit to be made.
Max length: 9 characters
Line 126. Account number Text
Enter the account number where you want the direct deposit to be made.
Max length: 17 characters
Line 127. Secondary Direct deposit amount Text
Enter the amount you wish to be directly deposited into a secondary account.
Max length: 12 characters
Line 127. Routing Number for secondary account Text
Enter the routing number for the secondary account where you want the direct deposit to be made.
Max length: 9 characters
Line 127. Secondary Account number Text
Enter the account number for the secondary account where you want the direct deposit to be made.
Max length: 17 characters
Exemptions
Line 6: If someone can claim you (or your spouse/Registered Domestic Partner) as a dependent, check the box here. See instructions CheckBox
Check this box if someone can claim you or your spouse/registered domestic partner as a dependent. Refer to the instructions for more details.
Line 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 Text
Enter the appropriate number based on the boxes you checked above. Refer to the instructions for more details.
Max length: 1 characters
Multiply the number you put in the line 7 box by $140. Enter this number into this field. Whole dollars only Text
Multiply the number you entered in the line 7 box by $140 and enter the result here. Use whole dollars only.
Max length: 12 characters
Line 8. Blind: If you (or your spouse/Registered Domestic Partner) are visually impaired, enter 1; if both are visually impaired, enter 2 Text
Indicate if you or your spouse/Registered Domestic Partner are visually impaired. Enter 1 if one person is visually impaired, or 2 if both are visually impaired.
Max length: 1 characters
Multiply the number you put in the line 8 box by $140. Enter this number into this field. Whole dollars only Text
Multiply the number entered in the Line 8 box by $140 and enter the result here. Use whole dollars only.
Max length: 12 characters
Line 9. Senior: If you (or your spouse/Registered Domestic Partner) are 65 or older, enter 1; if both are 65 or older, enter 2. See instructions Text
Indicate if you or your spouse/Registered Domestic Partner are 65 or older. Enter 1 if one person is 65 or older, or 2 if both are 65 or older.
Max length: 1 characters
Multiply the number you put in the line 9 box by $140. Enter this number into this field. Whole dollars only Text
Multiply the number entered in the Line 9 box by $140 and enter the result here. Use whole dollars only.
Max length: 12 characters
Line 11. Exemption amount: Add line 7 through line 10 Text
Calculate and enter the total exemption amount by adding the values from lines 7 through 10.
Max length: 12 characters
Filing Status
Check here if this is an AMENDED return CheckBox
Check this box if you are filing an amended return for the 2022 tax year.
Fiscal year filers only: Enter month of year end: Enter month as two digits for year 2023 Text
For fiscal year filers only: Enter the month of the year end as two digits for the year 2023.
Max length: 2 characters
If your California filing status is different from your federal filing status, check the box here CheckBox
Check this box if your California filing status is different from your federal filing status.
Line 1. Single CheckBox
Check this box if you are filing as single.
Line 2. Married or Registered Domestic Partner filing jointly. See instructions CheckBox
Check this box if you are married or a registered domestic partner filing jointly. Refer to the instructions for more details.
Line 3. Married or Registered Domestic Partner filing separately CheckBox
Check this box if you are married or a registered domestic partner filing separately.
Line 3. Enter spouse’s or Registered Domestic Partner’s SSN or I T I N above and full name here Text
Enter your spouse's or registered domestic partner's SSN or ITIN above and their full name here.
Line 4. Head of household (with qualifying person). See instructions CheckBox
Check this box if you are filing as head of household with a qualifying person. Refer to the instructions for more details.
Line 5. Qualifying surviving spouse or Registered Domestic Partner CheckBox
Check this box if you are a qualifying surviving spouse or registered domestic partner.
Line 5. Enter year spouse / Registered Domestic Partner died Text
Enter the year your spouse or registered domestic partner died.
Max length: 4 characters
Line 5. See instructions Text
Refer to the instructions for more details on this line.
Health Care Coverage
Line 91. If you and your household had full-year health care coverage, check the box. See instructions. Medicare Part A or C coverage is qualifying health care coverage. If you did not check the box, see instructions CheckBox
Check this box if you and your household had full-year health care coverage. Refer to the instructions for more details.
Income Details
Line 12. Total California wages from your federal Form(s) W-2, box 16 Text
Enter the total California wages as reported on your federal Form(s) W-2, box 16.
Max length: 12 characters
Line 13. Enter federal AGI from federal Form 1040, 1040-SR, or 1040-NR, line 11 Text
Enter your federal Adjusted Gross Income (AGI) from federal Form 1040, 1040-SR, or 1040-NR, line 11.
Max length: 12 characters
Line 14. California adjustments – subtractions. Enter the amount from Schedule CA (540NR), Part Two, line 27, column B Text
Enter the amount of California adjustments (subtractions) from Schedule CA (540NR), Part Two, line 27, column B.
Max length: 12 characters
Line 15. Subtract line 14 from line 13. If less than zero, enter the result in parentheses. See instructions Text
Subtract the amount on line 14 from the amount on line 13. If the result is less than zero, enter the result in parentheses. Refer to the instructions for more details.
Max length: 12 characters
Line 16. California adjustments – additions. Enter the amount from Schedule CA (540NR), Part Two, line 27, column C Text
Enter the amount of California adjustments (additions) from Schedule CA (540NR), Part Two, line 27, column C.
Max length: 12 characters
Line 17. Adjusted gross income from all sources. Combine line 15 and line 16 Text
Combine the amounts on lines 15 and 16 to calculate your adjusted gross income from all sources.
Max length: 12 characters
Line 19. Subtract line 18 from line 17. This is your total taxable income. If less than zero, enter 0 Text
Subtract the amount on line 18 from the amount on line 17. This is your total taxable income. If the result is less than zero, enter 0.
Max length: 12 characters
Line 32. California adjusted gross income from Schedule CA (540NR), Part 4, line 1 Text
Enter the California adjusted gross income as calculated on Schedule CA (540NR), Part 4, line 1.
Max length: 12 characters
Line 35. California Taxable Income from Schedule CA (540NR), Part 4, line 5 Text
Enter the California taxable income as calculated on Schedule CA (540NR), Part 4, line 5.
Max length: 12 characters
Miscellaneous
5011 RB_0 ComboBox
Select this radio button if applicable. Refer to the form instructions for more details.
5011 RB_1 ComboBox
Select this radio button if applicable. Refer to the form instructions for more details.
5015 RB_0 ComboBox
Select this radio button if applicable. Refer to the form instructions for more details.
5015 RB_1 ComboBox
Select this radio button if applicable. Refer to the form instructions for more details.
Payment Information
Line 121. AMOUNT YOU OWE. Add line 93, line 104, and line 120. See instructions. Do not send cash. Mail to: FRANCHISE TAX BOARD, Post Office BOX 942867, SACRAMENTO California 94267-0001. Pay Online – Go to ftb.ca.gov/pay for more information Text
Calculate the total amount you owe by adding line 93, line 104, and line 120. Follow the instructions for payment and mailing.
Max length: 12 characters
Line 124. Total amount due. See instructions. Enclose, but do not staple, any payment Text
Enter the total amount due as calculated. Refer to the instructions for details on how to calculate this amount. Enclose any payment, but do not staple it.
Max length: 12 characters
Payments
Line 81. California income tax withheld. See instructions Text
Enter the amount of California income tax that was withheld, as per the instructions.
Max length: 12 characters
Line 82. 2022 California estimated tax and other payments. See instructions Text
Enter the total of your 2022 California estimated tax payments and any other payments made, following the instructions.
Max length: 12 characters
Line 83. Withholding (Form 592-B and/or 593). See instructions Text
Enter the withholding amounts from Form 592-B and/or 593, as per the instructions.
Max length: 12 characters
Line 84. Excess State Disability Insurance (or Voluntary Plan Disability Insurance) withheld. See instructions Text
Enter the amount of excess State Disability Insurance or Voluntary Plan Disability Insurance withheld, as instructed.
Max length: 12 characters
Line 88. Add line 81 through line 87. These are your total payments. See instructions Text
Sum the amounts from lines 81 through 87 to calculate your total payments, as per the instructions.
Max length: 12 characters
Line 92. Payments after Individual Shared Responsibility Penalty. If line 88 is more than line 91, subtract line 91 from line 88 Text
If line 88 is more than line 91, subtract line 91 from line 88 to calculate the payments after the Individual Shared Responsibility Penalty.
Max length: 12 characters
Penalties
Line 91. Individual Shared Responsibility (ISR) Penalty. See instructions Text
Enter the Individual Shared Responsibility (ISR) Penalty amount, as instructed.
Max length: 12 characters
Line 93. Individual Shared Responsibility Penalty Balance. If line 91 is more than line 88, subtract line 88 from line 91 Text
If line 91 is more than line 88, subtract line 88 from line 91 to calculate the Individual Shared Responsibility Penalty Balance.
Max length: 12 characters
Penalties and Interest
Line 122. Interest, late return penalties, and late payment penalties Text
Enter any interest, late return penalties, and late payment penalties you owe.
Max length: 12 characters
Line 123. Underpayment of estimated tax. Checkbox A. Check the box if FTB 5805 is attached CheckBox
Check this box if you are attaching form FTB 5805 for underpayment of estimated tax.
Line 123. Underpayment of estimated tax. Checkbox B. Check the box if FTB 5805F is attached CheckBox
Check this box if you are attaching form FTB 5805F for underpayment of estimated tax.
Line 123. Underpayment of estimated tax Text
Enter the amount of underpayment of estimated tax.
Max length: 12 characters
Personal Information
Your first name Text
Enter your first name.
Middle Initial Text
Enter your middle initial. Only one character is allowed.
Max length: 1 characters
Last Name Text
Enter your last name.
Suffix Text
Enter your suffix, if applicable (e.g., Jr., Sr., III). Maximum 4 characters.
Max length: 4 characters
Your Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number or Individual Taxpayer Identification Number. It should be 9 digits long.
If joint tax return, spouse’s or Registered Domestic Partner's first name Text
If filing a joint tax return, enter your spouse's or Registered Domestic Partner's first name.
Middle Initial Text
Enter your spouse's or Registered Domestic Partner's middle initial. Only one character is allowed.
Max length: 1 characters
Last name Text
Enter your spouse's or Registered Domestic Partner's last name.
Suffix Text
Enter your spouse's or Registered Domestic Partner's suffix, if applicable (e.g., Jr., Sr., III). Maximum 4 characters.
Max length: 4 characters
Spouse's or Registered Domestic Partner's Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your spouse's or Registered Domestic Partner's Social Security Number or Individual Taxpayer Identification Number. It should be 9 digits long.
Foreign postal code Text
Enter your foreign postal code if you reside outside the United States.
Your Date of Birth (mm/dd/yyyy). Enter as a two-digit month/two-digit day/four-digit year Text
Enter your date of birth in the format MM/DD/YYYY.
Spouse's or Registered Domestic Partner's Date of Birth (mm/dd/yyyy). Enter as a two-digit month/two-digit day/four-digit year Text
Enter your spouse's or registered domestic partner's date of birth in the format MM/DD/YYYY.
Your prior name. (see istructions) Text
Enter your prior name if it has changed. Refer to the instructions for more details.
Spouse or Registered Domestic Partner's Prior Name (see instructions) Text
Enter your spouse's or registered domestic partner's prior name if it has changed. Refer to the instructions for more details.
Your name Text
Enter your full legal name as it appears on your official documents.
Your Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). This should be a 9-digit number.
Your name Text
Enter your full name.
Your Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number or Individual Taxpayer Identification Number. Ensure it is 9 digits long.
Your name Text
Enter your full name as it appears on your tax documents.
Your Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). This should be a 9-digit number.
Your name Text
Enter your full name as it appears on your tax documents.
Your Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number or Individual Taxpayer Identification Number. Ensure it is 9 digits long.
Preparer Information
Firm’s name (or yours, if self-employed) Text
Enter the name of your firm or your name if you are self-employed.
Firm's Preparer Tax Identification Number. Enter 9 digits Text
Enter the Preparer Tax Identification Number (PTIN) of your firm. The number should be 9 digits long.
Max length: 9 characters
Refund Information
Line 125. Refund or no amount due. Subtract line 120 from line 103. See instructions. Mail to: Franchise Tax Board, Post Office Box 942840, Sacramento, California, 94240-0001 Text
Enter the refund amount or indicate if no amount is due by subtracting line 120 from line 103. Refer to the instructions for more details. Mail the form to the Franchise Tax Board at the provided address.
Max length: 12 characters
Refund Options
Line 101. Overpaid tax. If line 92 is more than line 74, subtract line 74 from line 92 Text
If line 92 is more than line 74, subtract line 74 from line 92 to calculate the overpaid tax.
Max length: 12 characters
Signature Information
Date signed. Enter date as a two-digit month/two-digit day/four-digit year Text
Enter the date you signed the form in the format MM/DD/YYYY.
Tax Calculation
Line 31. Tax. Checkbox A. Check the box if from: Tax Table CheckBox
Check this box if your tax is calculated from the Tax Table.
Line 31. Checkbox B. Check the box if tax from Tax Rate Schedule CheckBox
Check this box if your tax is calculated from the Tax Rate Schedule.
Line 31. Checkbox C. Check the box if tax from FTB 3800 CheckBox
Check this box if your tax is calculated from FTB 3800.
Line 31. Checkbox D. Check the box if tax from FTB 3803 CheckBox
Check this box if your tax is calculated from FTB 3803.
Line 31. Tax amount Text
Enter the total tax amount calculated.
Max length: 12 characters
Tax Calculations
Line 36. California Tax Rate. Divide line 31 by line 19. Enter first digit before decimal point Text
Enter the first digit before the decimal point of the California tax rate, which is calculated by dividing line 31 by line 19.
Max length: 1 characters
Line 36. Enter 4 digits after decimal point Text
Enter the four digits after the decimal point of the California tax rate, which is calculated by dividing line 31 by line 19.
Max length: 4 characters
Line 37. California Tax Before Exemption Credits. Multiply line 35 by line 36 Text
Enter the California tax before exemption credits, which is calculated by multiplying line 35 by line 36.
Max length: 12 characters
Line 38. California Exemption Credit Percentage. Divide line 35 by line 19. If more than 1, enter 1.0000. Enter first digit before decimal point Text
Enter the first digit before the decimal point of the California exemption credit percentage, which is calculated by dividing line 35 by line 19. If the result is more than 1, enter 1.0000.
Max length: 1 characters
Line 38. Enter 4 digits after decimal point Text
Enter the four digits after the decimal point of the California exemption credit percentage, which is calculated by dividing line 35 by line 19. If the result is more than 1, enter 1.0000.
Max length: 4 characters
Line 39. California Prorated Exemption Credits. Multiply line 11 by line 38. If the amount on line 13 is more than $229,908, see instructions Text
Enter the California prorated exemption credits, which is calculated by multiplying line 11 by line 38. If the amount on line 13 is more than $229,908, refer to the instructions.
Max length: 12 characters
Line 40. California Regular Tax Before Credits. Subtract line 39 from line 37. If less than zero, enter 0 Text
Enter the California regular tax before credits, which is calculated by subtracting line 39 from line 37. If the result is less than zero, enter 0.
Max length: 12 characters
Line 41. Tax. See instructions. Checkbox A. Check the box if from: Schedule G-1 CheckBox
Check this box if the tax amount is from Schedule G-1.
Line 41. Checkbox B. Check the box if from FTB 5870A CheckBox
Check this box if the tax amount is from FTB 5870A.
Line 41. Tax amount Text
Enter the tax amount for line 41.
Max length: 12 characters
Line 42. Add line 40 and line 41 Text
Enter the sum of line 40 and line 41.
Max length: 12 characters
Line 63. Subtract line 62 from line 42. If less than zero, enter 0 Text
Subtract the amount on line 62 from the amount on line 42. If the result is less than zero, enter 0.
Max length: 12 characters
Line 71. Alternative Minimum Tax. Attach Schedule P (540NR) Text
Enter the amount for the Alternative Minimum Tax. Attach Schedule P (540NR) as required.
Max length: 12 characters
Line 72. Mental Health Services Tax. See instructions Text
Enter the amount for the Mental Health Services Tax as per the instructions provided.
Max length: 12 characters
Line 73. Other taxes and credit recapture. See instructions Text
Enter any other taxes and credit recapture amounts as instructed in the form's guidelines.
Max length: 12 characters
Line 74. Add line 63, line 71, line 72, and line 73. This is your total tax Text
Sum the amounts from lines 63, 71, 72, and 73 to calculate your total tax.
Max length: 12 characters
Line 102. Amount of line 101 you want applied to your 2023 estimated tax Text
Enter the amount from line 101 that you want to apply to your 2023 estimated tax.
Max length: 12 characters
Line 103. Overpaid tax available this year. Subtract line 102 from line 101 Text
Enter the overpaid tax available this year by subtracting line 102 from line 101.
Max length: 12 characters
Line 104. Tax due. If line 92 is less than line 74, subtract line 92 from line 74 Text
Enter the tax due by subtracting line 92 from line 74, if line 92 is less than line 74.
Max length: 12 characters
Third Party Information
Firm's address Text
Enter the address of the firm that is preparing your tax return.
Firm's Federal Employer Identification Number. Enter 9 digits Text
Enter the Federal Employer Identification Number (FEIN) of the firm preparing your tax return. This should be a 9-digit number.
Max length: 10 characters
5025 RB_0 ComboBox
Select this option if the firm preparing your tax return is not authorized to discuss your return with the tax authorities.
5025 RB_1 ComboBox
Select this option if the firm preparing your tax return is authorized to discuss your return with the tax authorities.
Print Third Party Designee’s Name Text
Enter the name of the third party designee who is authorized to discuss your tax return with the tax authorities.
Third party designee's telephone number. Enter 10 digits Text
Enter the telephone number of the third party designee. This should be a 10-digit number.
Voluntary Contributions
Code 400. California Seniors Special Fund. See instructions Text
Enter the amount you wish to contribute to the California Seniors Special Fund. Refer to the instructions for more details.
Max length: 12 characters
Code 401. Alzheimer's Disease and Related Dementia Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Alzheimer's Disease and Related Dementia Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 403. Rare and Endangered Species Preservation Voluntary Tax Contribution Program Text
Enter the amount you wish to contribute to the Rare and Endangered Species Preservation Voluntary Tax Contribution Program.
Max length: 12 characters
Code 405. California Breast Cancer Research Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Breast Cancer Research Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 406. California Firefighters’ Memorial Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Firefighters’ Memorial Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 407. Emergency Food for Families Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Emergency Food for Families Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 408. California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 410. California Sea Otter Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Sea Otter Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 413. California Cancer Research Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Cancer Research Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 422. School Supplies for Homeless Children Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the School Supplies for Homeless Children Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 423. State Parks Protection Fund/Parks Pass Purchase Text
Enter the amount you wish to contribute to the State Parks Protection Fund/Parks Pass Purchase.
Max length: 12 characters
Code 424. Protect Our Coast and Oceans Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Protect Our Coast and Oceans Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 425. Keep Arts in Schools Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Keep Arts in Schools Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 431. Prevention of Animal Homelessness & Cruelty Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Prevention of Animal Homelessness & Cruelty Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 438. California Senior Citizen Advocacy Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Senior Citizen Advocacy Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 439. Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 440. Rape Kit Backlog Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Rape Kit Backlog Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 444. Suicide Prevention Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Suicide Prevention Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 445. Mental Health Crisis Prevention Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the Mental Health Crisis Prevention Voluntary Tax Contribution Fund.
Max length: 12 characters
Code 446. California Community and Neighborhood Tree Voluntary Tax Contribution Fund Text
Enter the amount you wish to contribute to the California Community and Neighborhood Tree Voluntary Tax Contribution Fund.
Max length: 12 characters
Line 120. Add code 400 through code 446. This is your total contribution Text
Add the amounts from code 400 through code 446 to get your total voluntary contributions.
Max length: 12 characters
Voter Registration
For voter registration information, check the box and go to sos.ca.gov/elections. See instructions CheckBox
Check this box if you want information about voter registration. Visit sos.ca.gov/elections for more details. Refer to the instructions for more information.