For all taxpayers who are required to file State Income Tax returns



Name of Bank Type of Account
Routing Number Account Number

State you lived in on December 31, 2007: County:
If you were not a resident of this state for the year, give the dates of residency.
From: To:
If you lived in another state during the year, give the state, county and dates of residency
State
County
From To
California Residents - Do You Qualify for Rent Credit?

Other Special Instructions or Miscellaneous Information

I (we) declare that to the best of my (our) knowledge, the information provided is true, correct and complete.
Taxpayer's Signature Date
Spouse's Signature Date