Form 1067A Schedule Fillable Nonresident Group Return Schedule
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

If the nonresident individual s CA total taxable income from all sources is more than $1 million then enter "Y" for yes or "N" for no Mental Health Services Tax See General Information for more information See Schedule 1067A Instructions Part I for more information "Y" or (a)SSN or ITIN(FEINS not allowed (c) + (d) (c) col (e) x 1% (e) x 12 3% (f) + (g) + col (g)Credit(h)Enter "Y" or "N" (h) then (h) then multiply (i)Mental Health Services Tax (or CA (Part I plus Part 2) (Use additional sheet(s) if necessary) (Use additional sheets if necessary ) 1067 Section H for more information 1067A 2 Total of Part II 3 Grand Total 7161143 7162143 allowed"N" Amount of deferred compensation deduction Attach this schedule to your California group Form 540NR CA corporation or CA Secretary of State file no CALIFORNIA SCHEDULE col (e) by 1% column Column (a) and (b) Column (c) Column (d) Column (g) Column (h) Column (i) Corporation nameFEINDBACA corporation or CA Secretary of State file numberPart II credits Deferredcompensation(e)CA source income less deferred compensation col Director s Director s Compensation from California Sources(f) Director s NameCA Wage Director s SSN or ITIN Electing Nonresident Directors Included in the Group Nonresident Return Electing Nonresident Individuals (Shareholders/Partners/Members) Included in the Group Nonresident Return Enter Enter the individual s distributive share of California source income from the business entity s taxable year ending in 2014 First name MI Last name(c) For Privacy Notice get FTB 1131 ENG/SP Form 1099 Form W 2 Health If the nonresident director s CA total taxable income from If the nonresident individual has a spouse/RDP include the spouse s/RDP s information in both columns If Yes in column incomeIncomeForm W 2 Mental multiply Net tax Nonresident Group Return Schedule Note: Note: Column (h) Part I S Corporation/Partnership/Limited Liability Company name SCH W 2) Schedule 1067A 2014 Side 2 See FTB Pub see instructions) Services Side 1 Schedule 1067A 2014 sources is more than $1 million then enter "Y" for yes or "N" for no Tax credit allowable TAXABLE YEAR Total CA source income(d) Total of Part I Total tax Total tax col TotalReported Withholding x 12 3%