Form 3532 - Head Of Household Filing Status Schedule
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1TAXABLE YEAR
CALIFORNIA FORM
2016
Head of Household Filing Status Schedule
3532
Attach to your California Form 540, Long or Short Form 540NR, or Form 540 2EZ.
Name(s) as shown on tax return
SSN or ITIN
Part I – Marital Status
1 Check one box below to identify your marital status. See instructions
a Not legally married/RDP during 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1a
b Widow/widower (my spouse/RDP died before 01/01/2016) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
c Marriage/RDP was annulled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
d Received final decree of divorce, legal separation, dissolution, or termination of marriage/RDP by 12/31/2016 . . . . . . . . . . . . . . .
1d
e Legally married/RDP and did not live with spouse/RDP during 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
f Legally married/RDP and lived with spouse/RDP during 2016. List the beginning and ending dates for each period when you
1f
lived together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
From:
To:
From:
To:
Part II – Qualifying Person
2 Check one box below to identify the relationship of the person that qualifies you for the head of household filing status. See instructions.
a Son, daughter, stepson, or stepdaughter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a
b Grandchild, brother, sister, half brother, half sister, stepbrother, stepsister, nephew, or niece . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2b
c Eligible foster child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2c
d Father, mother, stepfather, or stepmother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2d
e Grandfather, grandmother, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law,
2e
sister-in-law, uncle, or aunt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part III – Qualifying Person Information
3 Information about your qualifying person. See instructions.
First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SSN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DOB (MM/DD/YYYY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check one box below to identify the status of your qualifying child who is age 19 or older in 2016. See instructions.
a Full time student under age 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3a
b Permanently and totally disabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3b
4 Enter qualifying person’s gross income in 2016. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Number of days your qualifying person lived with you during 2016. See instructions . . . . . . . . . . . . . . . . . . . . . . . .
When calculating the total number of days your qualifying person lived with you, you may include any days your qualifying person was temporarily
absent from your home. For example, illness, education, business, vacation, military service, and, (in some circumstances), incarceration.
FTB 3532 2016
8481163
For Privacy Notice, get FTB 1131 ENG/SP.
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