HomeMy WebLinkAboutMINUTES - 07151986 - FC.1 To- BOARD OF SUPERVISORS
FROM: Vwra
Finance Committee
DATE:
. July 15, 1986 . vo`^' "J
SUBJECT:
RECOMMENDATION ON DOWNED TREE REMOVAL PROJECT
SPECIFIC REQUEST(S) OR RECOMMENDATION(S ) & BACKGROUND AND JUSTIFICATION
Recommendations:
1. Approve allocation of $3 , 000 each in Special District Augmentation
Funds and County General Drainage Maintenance Funds to act as the 200
county match funding fora Community Development Block Grant (Attachment A)
to remove downed trees for low and moderate income residents along natural
creeks in unincorporated areas of Contra Costa County;
2. Authorize the Chief Engineer as coordinator of the project to set
income eligibility criteria for residents of the unincorporated areas of
Contra Costa County as established by the most recent published income
limits set by HUD for the Community Development Block Grant Program in the
San Francisco Primary Metropolitan Statistical Area (PMSA) (Attachment B)
and
3 . Approve, as recommended by the Chief Engineer, initial concentration of
county work efforts in the San Pablo and Wildcat Creek Watershed areas
which have been identified by the Chief Engineer as having the most press-
ing problem of downed trees in unincorporated Contra Costa County.
Financial Impact:
A one-time expenditure of $3 , 000 of Special District Augmentation Funds and
$3 , 000 of County General Drainage Maintenance Funds.
Reasons for Recommendation/Background:
The County has secured a $30, 000 Community Development Block Grant to
assist in the removal of downed trees for low to moderate income persons in
unincorporated areas of Contra Costa County. The grant was awarded due to
a demonstrated need to remove downed trees which had been undercut by high
creek flows for an extended period. of time. The trees were not eligible
for removal under County General Drainage Maintenance Policy and City
Maintenance Policies. As a result, low to moderate income persons residing
along these affected creeks would have to bear the cost of removal. Such
costs could prove to be beyond the means of many of the low to moderate
income residents.
As condition of the award of CBDG funds the County was required to put
forth a 20% match. The amount needed is $6,000 and must be expended prior
to the use of the CBDG Funds.
CONTINUED ON ATTACHMENT: _ YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF B OMMITTEE
APPROVE OTyIeft^
1 �
SIGNATURE(S), Supervisor Tom Torlakson Su R rt Schroder
ACTION OF BOARD ON TU1 y 15, 1986 APPROVED AS RECOMMENDED X OTHER
VOTE OF SUPERVISORS
X. IV 1 HEREBY CERTIFY THAT THIS IS A TRUE
_ UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN,
cc: County Administrator ATTESTED __July 15, 1986
Community Development Director PHIL BATCHELOR, CLERK OF THE BOARD OF
Public Works Director SUPERVISORS AND COUNTY ADMINISTRATOR
B �G(�G ,DEPUTY
M382117-83
ATTACHMENT A
APPLICATION
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
Read Attached. Instructions Carefully
1. Proposed Project Description and Location
A. Title of Project: Assistance to low to moderate income report for downed .
tree removal in [west Contra County area.
B. Description of Project:
See attached letter
C. Location of Project:
1. Community: Contra Costa County
2. Address (if applicable): (Not Applicable)
3. Area to Be Served: Unincorporated areas of Contra Costa County
2. Proposed Project Costs All Funding Sources
Matching
Cost Item CDBG $ Funds * Total
A. Acquisition or lease of land, building or improve- 0 0 0
ments.
B. New construction including Public Works. 0 0 0 _
C. Renovation, rehabilitation, or reconstruction. $30 , 000 6 000 36 000 _
D. Planning, engineering, administration. 0 0 _ 0
E. Program, operational costs(attach list). 0 0 0
F. Other (describe on separate sheet). 0 _ 0 0 -
G. Totals: CDBG Funds Requested, $30 ,000 $6 , 000 $ 6 ,000
Matching Funds, All Funds --�----
*List source of matching funds included in-kind. Contra Costa County Drainage Maintenance
3. Proposed Responsible Agency/Organization and Source of Support Funds
A. Agency/Organization: Drainage Maintenance
B. Contact Person: Milton Kubicek Phone: (415) 372-4470
C. Address: 255 Glacier Drive, Martinez, CA 94553
D.. Budgeted Support Funds: $ 6 ,000 E. Source of Support Funds: Drain Maintenance
RETURN TO: Housing and Community Development Advisory Committee.
c/o Contra Costa County Community Development Department,
P. O. Box 951, Martinez, CA 94553
DEADLINE FOR SUBMISSION OCTOBER 4, 1985
OFFICE USE ONLY
Date Received:
Type of Project:
Eligibility:
Lower Income Benefit:
Additional Information Requested: Dater
2C
Board of Supervisors
County Administrator Contra Tom Powers
1st District
County Administration Building Costa Nancy C. Fanden
Martinez,California 94553 2nd District
(415)372-4080 COI I�/ Robert t.Schroder
Phil Batchelor
�-+, "r 3rd District
County Administrator Sunne Wright McPeak
4th District
Tom Torlakson
June 9, 1986 .� 5th District
Housing and Community Development
Advisory Committee
C/O CCC Community Development Department
P. O. Box 951
Martinez, CA 914533
Dear Committee Member:
Subsequent to your May 14, 1986 meeting, this letter is written as
a modification of our previous funding request: The request
addressed proposed assistance to homeowners for removal of downed
trees. The modifications to be considered are as follows:
Project Title:
Assistance to low and moderate homeowners for downed tree removal
in West Contra Costa County.
Project Description Addendum:
The proposed project would only provide financial assistance to low
and moderate income homeowners. Such assistance would be used to
remove downed trees out of creeks in West Contra Costa County.
This area has been specifically identified because county flood
control staff indicates it has one of the highest concentration of
downed trees in the county. County staff feels that long-term
solutions should be performed whenever possible. From the
allocation of funding, this project has the potential to provide
such relief in the West Contra Costa County area.
Removal of the trees will have a double benefit for the proposed
area' s homeowners. Erosion will be minimized, removing the
impending need for costly shoring up and grading of creek banks by
homeowners. Secondly, removal of the downed trees will serve to
further protect low and moderate homeowners from future and
prohibitive costly liability problems.
Housing & Community -2- June 9, 1986
Development Advisory Committee
Because of the economic status of the proposed project area
population, no shared charges or loan repayment agreements would be
levied. It is also anticipated that funding of this nature will
not be annual. This request is only being made because of problems
caused by last year' s "1 in 50 years" winter weather patterns.
Normal county flood control and maintenance activities would keep
county creeks and channels clear as dictated by county practice and
policy.
Project funds will be used as previously stated in the manner
outlined by our initial funding request. Trees identified for
removal are those most likely to cause drainage problems, threaten
future creek bank alignment or county facilities. Only large trees
with a diameter of at least 10 inches measured three feet from the
base would be removed. Smaller trees must be the sole responsi-
bility of the property owner.
Affected homeowners would be notified by public correspondence that
such a program exists. It is the responsibility of the homeowners
to apply for work to be performed. The work will be limited to the
amount of funds allocated, and is restricted to a schedule to be
determined by Flood Control District Personnel.
Project Cost:
An amount of $30,000 is requested to remove the downed trees in
West Contra Costa County for low and moderate income homeowners.
The County' s 20o share would be $6,000.
Project Personnel:
A majority of the project labor will be accomplished through
combined efforts of California Conservation Corps and County
drainage maintenance personnel.
Although our request is outside your normal funding cycle, it is
felt that the proposal is justifiable because of the unique
conditions and problems. Obviously there are many more county
areas that require attention, however, it is our opinion that a
shotgun approach will do little to provide long-term solutions.
The policy of long-term solutions is the direction that county
flood control staff has recommended and proceeding towards.
Very truly yours,
John T. Gregory
Administrative Analyst
JTG:mak
ATTACHMENT B
INCOME LIMITS BY HOUSEHOLD SIZE
MAXIMUM ADJUSTED
ANNUAL GROSS INCOME
Persons Low and Moderate
Per Household Households
1 $18,700
2 21,350
3 24,050
4 26,700
5 28,350
6 30,050
7 31,700
8+ 33,400
"Low and Moderate Income" Households, for purposes of the Downed Tree Removal
Program, are defined as having an adjusted gross income of not more than 80% of
the PMSA median income, as adjusted for household size. This table incorporates
the most recently HUD published income limits for the Community Development
Block Grant Program in the San Francisco PMSA. HUD adjusts these figures from
time to time and the County program will use the most current available figures.
JK/mb1T
{ r
Department of the Treasury—Internal Revenue Service
l-�
1040 `C`��VJJJ'
4 4 U.S. Individual income Tax Return (o)
For the year January 1-December 31,1985,or other tax year beginning 1985.ending .19 0M8 No.1545d0074
Use . '', Your first name and initial(if joint return,also give spouse's name and initial) Last name Your social security number
,z IRS
•' label.
other- Present home address(number and street,including apartment number,or rural route) Spouse's social security number
�? plea,
.'.�:; ,• lease
print City,town or post office,state,and ZIP code Your occupation
or type. Spouse's occupation
Presidential ' Do you want$1 to go to this fund? Yes NO Note:Checking"Yes"will
r`7 not change your tax or
Election Campaign If joint return,does your spouse want$1 to go.to this fund.. . Yes No reduce your refund.
Single For Privacy Act and Paperwork Reduction Act Notice,see Instructions.
.. 1
Filing Status 2 Married filing joint return even if only one had income
' 3 Married filingseparate return.Enter spouse's social security no.above and full name here.
Check only p
!'J one box. 4 Head of household(with qualifying person).(See page 5 of instructions.)If the qualifying person is your unmarried child
but not your dependent,write child's name here.
5 Qualifying widow(er)with dependent child(year spouse died ►19 ).(See page 6 of instructions.)
'
..F. 6a Yourself 65 or over Blind . Enter number of
Exemptions 65 oozes checked ❑
p b Spouse or.over Blind on 6a and b 1110-
c First names of your dependent children who lived.with you Enter number
t. x Always check of children
the box labeled
listed on 6c ►
r' Yourself. d First names of your dependent children who did not live with you'(see page 6). l Enter number
Check other } of children ❑
boxes if they if pre-1985 agreement,check here ►❑ .)
(3)Number of 4 Did dependent listed on 6d ►
apply. a Other dependents: () (or Did you provide
(2)Relationship months lived . bare income of more than one half of
�4 (1)Name in your fiome. 51,040 or more? dependent's support? Enter number ❑
ry of other
dependents I.
Add numbers
entered in
I Total number of exemptions claimed(also complete line 36). boxes above ►
Y`a°? 7 Wages,.salaries,tips,etc.(Attach Form(s)W-2.). 7'..'
•- .-..x
Income 8
7 8 Interest income(also attach Schedule B if over$400) .
Please attach 9a Dividends(also attach Schedule B if over$400) I '96 Exclusion MINE
- Copy B of your 9c
Forms W-2,W-2G, c Subtract line 9b from line 9a and enterthe result. .
10
and W-21P here. 10 Taxable refunds of state and local income taxes,if any,from the worksheet on page 9 of Instructions.
If you do not have 11 Alimony received .
page 4 see 12 Business Income or(loss)(attach Schedule Q. : 12
of
Instructions. 13 Capital gain or(loss)(attach Schedule D) .13
14 40%of capital gain distributions not reported on line 13(see page 9 of Instructions) 14
15 Other gains or(losses)(attach Form 4797) . . . . . . . . . . . . . . 15
.� 16 Fully taxable pensions,IRA distributions,and annuities not reported on line 17(see page 9). , 16
17a Other pensions and annuities,including rollovers.Total received 117a
b Taxable amount,if any,from the worksheet on page 10 of Instructions . . . . . . . . 17b
I . . . . . . . 18 I--- 18 Rents,royalties,partnerships,estates,trusts,etc.(attach Schedule E)
19 Farm income or(loss)(attach Schedule F) . . . . . . . . . . 19
20a Unemployment compensation(insurance).Total received 20a
Please b Taxable amount,if any,from the worksheet on page 10 of Instructions. . . . . 20b
attach check21a
or rnone 21a Social security benefits(see page 10).Total received. . . I
order dere. b Taxable amount,if any,from worksheet on page 11. I Ta.rY es pt ( 121b
22 Other income(list type and amount—see pzge 11 of Instructions)._
_ 22 1
23 Add Imes 7 through 22.This Is your total income. ► 123
24 Moving expense(attach Form 3903 or 3903F) . . . . 24 C%'•/;r; I
Adjustments 25 Employee business expenses(attach Form 2106). . . . 25
to Income26
26 IRA deduction,from the worksheet on page 12 _ 4
27
(See 27 K?ogh retirement plan deduction . . . . . ;
t— —�-—
jrt:
28
Instruct ons 28 Penalty on early withdrawai of savings . . .
5.s on page 1 i.) 29 Almon paid(recipient s last name
�,'t':... Y. ( p ---. — and a•
r:� �•::i•' .
..-Titer
29 .,.;
_ social security no30
30 Deauc'on fora married couple when both work(attach5chedulc iV)
31 Add lines 24 t`-,rough 30.These are your total adjustments . 1 31
Adjusted 32 Subtract line 31 from line 23. This is your adjusted gross income.if this line is less than I
$11,1700 and a child trued with you, see "Earned Income Credit''(line 59)on page 16 of
Gross Income instructions. If you want IRS to figure your tax,see page 13 of Instructions . ► 132
e �
I'�•at Form Department of the Treasury—Internal Revenue Service
h x" 1040A US Individual Income Tax Return (o) 1985 OMB No.1545-0085
Step 1
Use the IRS mailing label.If you don't have one,print or type:
Name and Your first name and initial(if joint return,also iiVe spares tame and initiap i4st name Your social security no.
address
Present home address(number and stmt) Spouse's social security no.
City,town or post office,state,and ZIP code
Presidential Election Campaign Fund
Do you want$1 to go to this fund?. . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
If joint return,does your spouse want$1 to go to this fund?. ❑ Yes ❑ No
Step 2 1 ElSingle(See if you can use Form 1040EZ.)
Check your 2 ❑ Married filing joint return(even if only one had income)
filing status 3 ❑ Married filing separate return.Enter spouse's social security number above
(Check only one) and spouse's full name here.
4 ❑ Head of household(with qualifying person).If the qualifying person is your unmarried child
but not your dependent,write this child's name here.
Ste 3
S :;F4 Always check the exemption box labeled Yourself.Check other boxes if they apply.
.` Figure your 5a❑ Yourself ❑ 65 or over
-` exemptions ❑ Blind Write
bo es bar
b❑ Spouse ❑ 65 or over ❑ Blind checked on 5a and b
c First names of your dependent children who lived with you
_-
Write number of
children listed on Sc
= ' d First names of your dependent children who did not live with
ou(see page 11).(If pre-1985 agreement check here ❑ .)
-`�''-:Y�;'• Attach Copy B of Y r
Form(s)W-2 here Write number of
children listed on 5d
e Other dependents: 3.Number of 4.Did dependent S.Did you provide more '
months lived have income of than one-)alta(
1.Name 2.Relationship in your home. $1,040 or more? dependent's support?
Write number of
other dependents
x listed on Se
- ❑
Add numbers
- f Total number of exemptions claimed.(Also complete line 18.) entered
on linea above
Step 4 6 Total wages,salaries,tips,etc.This should be shown in Box 10
Figure your of your W-2 form(s).(Attach Form(s)W-2.) 6
total Income 7 Interest income. (If the total is over$400,also attach Schedule 1,
Part III.) 7
8a Dividends. (If the total is over$400,also attach Schedule 1,Part IV.)
Total. 8a 8b Exclusion(see page 16). 8b
Attach check or
. � h money order here
c Subtract line 8b from line 8a.Write the result on line 8c. 8c
9a Unemployment compensation (insurance),from
-' Form(s) 1099-G.Total received. 9a
b Taxable amount,if any,from the worksheet on page 17 of the instructions. 9b
10 Add lines 6,7,8c,and 9b.Write the total.This is vour total income. ► 10
Step 5 11 Individual retirement arrangement(IRA)
Figure your deduction,from the worksheet on page 19. 11
adjusted 12 Deduction for a married couple when both work.
gross Complete and attach Schedule 1,Part I. 12
Income
' 13 Add lines 11 and 12. Write the total.These are vour total adjustments. 13
14 Subtract line 13 from line 10. Write the result.This is your adjusted
gross income. ► 14
For Privacy Act and Paperwork Reduction Act Notice.see page 41. Form 1040A (1985)
= % . Department of the Treasury-Internal Revenue Service
.`? y
r Form Income Tax Return for
1040EZ Single filers with no dependents (o) 185 OMB No.1545.0675
Name& Use the IRS mailing label.If you don't have one,please print: Please print your numbers like this.
�= address 1 2 3 T S 6 7 8 g Q
=� Your social securitynumber
Print your name above(fust.initial,last)
Present home address(number and street)
City,town.or post oboe,state,and ZIP code
Presidential Election Campaign Fund
,>> Do you want$1 of your tax to go to this fund?
Figure
your 1 Total wages,salaries,and tips.This should be shown in Box 10
.:a:;>>
i tax of your W-2 form(s).(Attach your W-2 form(s).) 1
�
2 Interest income of$400 or less.If the total is more
-- than$400,you cannot use Form 1040EZ. 2
_ Attach 3 Add line 1 and line 2.This is your adjusted gross income. 3
Copy B of
= Form(s) 4 Allowable part of your cash charitable contributions.
W-2 here
'="= See instructions for line 4 on back of this form. 4
5 Subtract line 4 from line 3. 5
1 040 O O
6 Amount of your personal exemption. 6
7 Subtract line 6 from line 5.If line 6 is larger than•line 5,
= enter 0 on line 7.This is your taxable income. 7
8 Enter your Federal income tax withheld.This should be
shown in Box 9 of your W-2 form(s). 8
9 Use the single column in the tax table on pages 31-36 of
the Form 1040A instruction booklet to find the tax on
-, your taxable income on line 7.Enter the amount of tax. 9
Refund
<;¢ Or 10 If line 8 is larger than line 9,subtract line 9 from line 8.
amount Enter the amount of your refund. 10
you owe 11 If line 9 is larger than line 8,subtract line 8 from line 9.
Attach tax Enter the amount you owe.Attach check or money order
payment here for the full amount,payable to"Internal Revenue Service." 11
Sign I have read this return. Under penalties of perjury, I declare
your that to the best of my knowledge and belief,the return is true,
return correct,and complete.
Your signature Date
For Privacy Act and Paperwork Reduction Act Notice,see page.41. Form 1040EZ(1985)
t '
CALIFORNIA FORM TAX YEAR
Resident
ti
540Personal Income Tax 1985
=.' For Privacy Act Notice,see InStruCtionS. For the ear January 1-December 31,1985,or othei lair aeboinniho 1985,.endi 1986.
- Use California prea dressed label it one was mailed to you.Otheiwise, please print or type. 00 NOT.WRITE
.-: ;•`.' Your first name and initial(if ioint return,also give spouse's name and initial) Last Name Your social security number IN THESE SPACES
r ; E. -
Spouse's social security number St`s'•
.; Present home address(Number and street,including apartment number,P.O.Box.or rural route) Your occupation
'W A.
City,town or post office,State and ZIP code Spouse's occupation
R•. ...::
'.4
in t: n r:
f
119 ....;..
If Ftl latus.. or.3 checked a to 342•:';���
ilio Status:
;4'._r:°.,.. .' .. .'nter..::,>
P rsonal -`= :: ff f St tus 2 0 5 checked.a 584':,:"
2 Married filing joint return(even if only:one had income ..:':: 7.. e.. g..
• If Ilr� Statua�6 cMarria d fiGn .se orato return—Enter spOuse's.soci 1 hecke a to
36
7 00
3 SLTcu
rity number above and full name here f If ou:orours ousels visually.impaired
8 Blind enter 313 If both are visually Impaired
c
c —
Head of household=See instructions for.Filing.Status o ;..,
nter 26 8 1 00
e 3
4 Enter name and relationship.of qualifying person.(do :::;;; ;;: �. .9.Dependents -0o not'include yourself,.your apouse'or ttie;;
t
not list yourself or spouse): .person who qualifies you as Head of household,or'Joint• .
:„ E custody:head of houset old.. nter.name and relationship.
•-r; Qualifying Widow(er)with dependent child.(year.spouse. W
5 died 19_J See' instructions for filing Status:Enter..:.:°,.; :: :•;.'
name of ualifyin dependent at line 9. _
LL Jotnt custody head of household—See instructions for, ;:: '° `_:pumber ot'De Dependents �: X 313► 9 00 .:
6 Filing Status..Enter:name of.qualifying child 10.Total exemption credits(add lines 7;:8:and 9),enter.here:and
-;. onstde2 line52 .:"::':•:::;; . :;'.'`.::...:`::....":;::. ::::...:`..: 10 00
me 12 . .Wages,salaries tips,etc. .
Incops, � 12
'Y Interest If more than$400,complete Schedule B 540 13
'• Please.
attach copy 14 Dividends—before Federal exclusion(if more than$400,.complete:Schedule:6(540)) : ± `. 14
of your .., :,
_— yo
1
Ilm n
r 5
15 A o Iv .....
Y
received.
ed.
Form(s)W-2.
here. 16 Business income or(Ioss)(attach Schedule C-E-F(540)). :: :.::: :. 16
17. ..'Capital gain or loss attach Schedule 0 540 . .
17.
If you do not ... .:..... ..... , .......
have a.w-2, 18 Supplemental gains or(losses)(attach Schedule 0=1(5 40)). " ;:.:.: 18
see 19 Fully taxable pensions.IRA distributions, and annuities not reported on line 20 19
-- ... ...............
instructions
20a Partly taxable pensions and annuities.Total received 20a
.{y ...:
b Taxable amount,if any.(See Zine 20 instructions) ' .:' ..:....... ..... 20b
:- 21 Rents,royalties,partnerships,estates and trusts["aitach'schedule 21
:.:.. ..
22 Farm income or(loss) . .. . ... . .. .... .
27 Other income(state nature and source) 27
28 Total income. Add lines 12 through 27 . . . .. . . . . . . ... ... .. . . .. . . . .. .. ... . . . . .. . . . . . .. .. .
Adjustments 29 Moving expense(attach FTB 38050). . ... .:... . . . . . . ... . .. ... . . .. . . ...... .. . .......... ... . 29
to Income 30 Employee business expenses(attach FTB 3805N) .. . . . .. .. . ..... . . . . . . . ... . . . . . ..
FPleae31 Limited IRA payments(see line 31 instructions) . .You$ Spouse$ 31 If Simplified Employee Pension Plan check here: You Spouse
32 Payments to a Keogh(H.R. 10)retirement plan(see line 32 instructions) . .. . . . .... . .. . . . . . . .... . 32
33 Payments to a self-employed"Defined Benefit Plan"(see line 33 instructions). . ... . .......... ... . 33
35 Penalty on early withdrawal of savings . . .. .... . . . . . .. . .. . ... . . . .. . . .. ....... . . .. . . . . . . . . . 35
36 Alimony paid. Recipients name: and
Social Security Number (see line 36 instructions) . . . . .. ... • 36
37 Exclusion: a 65 or Over--b MilitaryTotal a and b . . . . . .. . . . . • • 37
42 Total adjustments.Add lines 29 through 37 . . . . . . . . . .. . . . . . . .. . . . . .. . . . . .. . . .. . .. . .. • 42
. . . . . . .. . . . . .. . . . . .
Adjusted 43 Adjusted 2. . . .. .. . . . . . . . . . .
usted gross income. Subtract line 42 from line 28, and continue
Gross
. . . . . . .
Income On side . . . . . . . . . . . . . . . . . .
1 43
Form 540 1985 Side 1
a CALIFORNIA FORMResident TAX YEAR
540A Personal Income 'Pax 1985
For Privacy Act Notice,see Instructions. For the year January 1—December S1.1985,or other tax year beginning 1985,ending 19%.
Use California preaddressed label if one was mailed to you.Otherwise, please print or type. DO NOT.WRITE
INSPACES.-
Your
:.
THESE SPACES..
Your first name and initial(it pint return,also give spouse's name and initial I Last name Your social security number E
Spouse's social security number P
::
A
-' Present home address(Number and street,including apartment number.P.O.Box.or rural route) Your occupation
M
City.town or post office.State and ZIP code Spouse's occupation
R
r' 1
Single If Filing Status 1 or 3 checked, enter$42
m 7 Personal—if Filing Status 2 or 4 checked, enter$84.
Married filing joint return even if onlyone had income If Filing Status 6 checked,enter$63 7 00
Married filing separate return—Enter spouse's social If you or.your spouse is visually.impaired, enter.$13.
security no.above and full name here m 8 .Blind— If both are visually impaired,enter$26.: 8 00
Dependents-Do not include.yourself, your spouse or the
Head of household—See instructions. Enter name and ° person who qualifies you as Head of household;:or Joint
4 relationship of qualifying person(do not list yourself or C custody head of household.Enter name and relationship....:
=a spouse) o
0 fi Joint custody head of household—See instructions for to Number of Dependents 0 X$13 9 00
Filing Status.Enter name of qualifying child 10 .Total exemption credits (add lines 7, 8 and 9) enter here
U. and on line 52 . .. 10 00
12 Wages,salaries,tips,etc. .... ........... ... 12
Please 13 Interest(if more than$400,complete Part 11 on side 2) .. . ...::: .. 13
attach copy 14Dividends—before Federal exclusion(if more than$400,complete Part III on side 2)::...:,.... :.:...... 14
of your
Form(s)W-2 28 Gross Income.Add lines 12,13,and 14 ...., .:: 28
1 here. 37 Exclusions: a 65 or Over b Military Amount from.a and b . • 37
-_;Z If you do 43 Adjusted gross income.Subtract line 37 from line 28 ;: :... 43-
not have a 48 Allowable charitable contributions.(see instructions on page 5)...:,..:.... ... ....... .. • 48
W-2,See50 Taxable income.Subtract line 48 from line 43..... 50
page 6 51 Tax.Use the amount on line 50 to find your tax from the tables on pages 12 through 15 ::....: : 51.
52 Exemption Credits.Enter amount from line 10 above .. ......... . . .. ................... 52
53 Credit for child and dependent care expenses(see instructions on page 5) . :.......
54 Net tax.Subtract the sum of lines 52 and 53 from line 51. If less than zero,enter zero.......... 54
70 Special low income credit(see instructions on page 5) .. .... ... ....... ........ • 70
76 Total Tax Liability.Subtract line 70 from line 54 ...... ... . . ...... .... . .. . ........... ... • 76
77 Total California Income tax withheld from Form(s)W-2. . ... . . .. ... .■ 77
79 Renter's Credit—You must complete Part I on side 2 . . .... .. ......■ 79
80 Excess California SDI tax withheld (see'"structionsordyif you ■ 80
had more than one employer)' ''''' ' -
-
81 Total.Add lines 77,79 and 80 . . . . . . . . ... ....... . . . . . . ... ..... .:. . .. ...... .
82 If line 81 is larger than line 76,enter amount of overpayment . ... ... .. ..... . . ..... .............■ 82
85 If line 76 is larger than line 61,enter amount of tax due. .... ....... .. . . .. .......... ...:....:..■ 85
Voluntary Contributions. $1 or more (see instructions on page 6)
-�` California Election 87 You:Enter political party Amount($25 max) ► 87
Campaign Fund 88 Spouse: Enter political party Amount($25 max) p- 88
89 California Fund for Senior Citizens . . . . .. . .. . . . . . . . . . . . . ... . . . . ... . .. . ...... ..Amount • 89
90 Rare and Endangered Species Preservation Program. . . . . . . . . . . . . . .: . ... . .. . . . . . .Amount • 90
Please 91 State Children's Trust Fund for the Prevention of Child Abuse . . ... . . .. . . . . . ... . . .. . .Amount • 91 _
attach check 92 United States Olympic Committee Fund . ... . . . . . . . . . . .. . . . . ... ......... ..... ..Amount • 92
or money h 92
h
87 Add l
i
b
C
3 Total Contributions(Add through . . . . . ... . . . .. . . . . . . .
order Here. .. . ..... . . .. . . . . . ... • 93
95 Refund.Line 82 minus line 93. Mail to Franchise Tax Board,Sacramento,CA 95840.0061 95
96 Amount Owed. Add lines 85 and 93. Attach payment made to Franchise Tax Board. Include social
security.number on payment. Mail to: Franchise Tax Board,Sacramento,CA 95667.0041. 96
Please unaer pena�t es of oeriury l r, care that I have examined this return and to the best of my knowledge and belief,it is true.correct.and complete. Declaration of preparer
(other Ihan iarpa'yefl is oased on aii information of wnich preparer has any knowledge.
Sign
Here — - - -- -
Your s.gnaiu, _ ___ Date Soouse s signature Id filing jointly.BOTH must signy
Paid S-Qnaiure pt P'e�arer A^-J,ess
Preparers
1 F.rm s Name(Yours-t%1 e(Tip;,u,-'JI Soc,al Security or Emoloyer Number
InlOrrna!IOn 2
i
''T
ao
U? CJs 3J w C
, c o 0o
% p A ro
p
M
r:r a 3
N - ^
c fl
O Y
oY
t � s
m
O ¢ s
O
C
,. Ca Q � ti 2 a � •= O
o � g
� n» � �'. �=• o ti 9 '". Nom" �.
G : co {
CO
A
N d C O C
- M
io 0 3 ° cr
_ 14
de
co
_ < N n � X /•� CJ9
< ^
� A
o
t N C— n ? PO
A 3
Im N m
O rco {fl. U K
c 3 3 w A O
:-•.Ty"'2::., � .... � � � �.. moi• i � O '� -C
� C
3 C
r•