
Your first name Last name Your SSN or ITIN
If filing jointly, spouse’s/RDP’s first name Last name Spouse’s/RDP’s SSN or ITIN
Address (include number and street, PO Box, or PMB no.) Apt. no./Ste. no. Telephone number
( )
City State ZIP Code
I elect not to e-file my tax return.
Reason (optional):_______________________________________________________________________
Part I: Taxpayer Information
e-file Opt-Out Record for Individuals
TAXABLE YEAR
CALIFORNIA FORM
8454
DO NOT MAIL THIS FORM TO THE FTB
For Privacy Notice, get form FTB 1131. FTB 8454 C3 (2010)
Your signature Date
Spouse’s/RDP’s signature (if filing jointly) Date
Part II: Tax Preparer Information
I am not e-filing this taxpayer’s return due to reasonable cause.
Explanation:____________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Paid preparer’s signature Date
Paid preparer’s name SSN/PTIN
Firm’s name (if applicable) FEIN
Firm’s address Telephone number
( )
City State ZIP Code
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General Information
California law requires individual income tax returns prepared by certain income tax preparers to be electronically filed
(e-filed) unless the taxpayer elects not to e-file or the tax preparer cannot e-file the return due to reasonable cause. Use
this form to record when and why the return was not e-filed.
Do not mail this form to FTB. Please keep it for your records.
For married/registered domestic partners (RDPs) filing jointly, only one spouse/RDP needs to sign.
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