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California Free Printable CDTFA-403-E for 2024 California Individual Financial Statement (California Department of Tax and Fee Administration)

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Individual Financial Statement (California Department of Tax and Fee Administration)
CDTFA-403-E

CDTFA-403-E (FRONT) REV. 12 (3-18) STATE OF CALIFORNIA INDIVIDUAL FINANCIAL STATEMENT PLEASE TYPE OR PRINT CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION ACCOUNT NUMBER Respond By: Please attach copies of your income tax returns for the last two years. Documentation is required to support your income and expenses. NAME (first and initial) LAST SOCIAL SECURITY NUMBER (SSN) PRESENT HOME ADDRESS (number and street or rural route) STATE ZIP SPOUSE/DOMESTIC PARTNER (SSN) HOME TELEPHONE CHILDREN LIVING WITH YOU CELL PHONE PRESENT EMPLOYER EMPLOYER’S TELEPHONE EMPLOYER’S ADDRESS LENGTH EMPLOYED OCCUPATION PERSONAL EMAIL ADDRESS SPOUSE/DOMESTIC PARTNER PRESENT EMPLOYER EMPLOYER’S TELEPHONE EMPLOYER’S ADDRESS LENGTH EMPLOYED OCCUPATION BUSINESS EMAIL ADDRESS MONTHLY GROSS INCOME Interest received from: Pensions Social Security Alimony/child support received: Other (please explain) TOTAL MONTHLY INCOME - / / OTHER DEPENDENTS STATE EXP. DATE SPOUSE/DOMESTIC PARTNER (DL) STATE EXP. DATE BANKS, CREDIT UNIONS, and OTHER FINANCIAL INSTITUTIONS Address Type of Accounts MONTHLY GROSS INCOME MONTHLY INCOME Dividends received from: / SPOUSE/DOMESTIC PARTNER (DOB) DRIVER LICENSE NUMBER (DL) Name Monthly take-home pay Dates paid: Spouse/domestic partner monthly take-home pay Dates paid: / NAME OF SPOUSE/DOMESTIC PARTNER CITY, TOWN, OR POST OFFICE DATE OF BIRTH (DOB) - MONTHLY EXPENSES $ 1 $ $ $ 2 3 4 5 6 $ $ $ $ $ 7 8 9 10 11 11 12 13 14 15 MORTGAGE / RENT PAYMENT Rent payment - Landlord telephone: Mortgage or Name: Address: Food: Housekeeping supplies: Apparel and services: Personal care products and services: Transportation (work related only – do not include car payment): COURT ORDERED Child support Alimony Other (attachment) Payable to: Telephone: Address: Utilities (electric/gas, water, trash, telephone): Childcare/dependent care, paid to: Health care expenses (not paid by insurance): INSURANCE EXPENSE* Car $ Life $ Home $ Health $ Miscellaneous (please explain) Total expenses (add lines 1 through 12) Total of recurring monthly payments (from page 2, line 10) Total monthly expenditures (add lines 13 and 14) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ *Not paid through payroll deductions CDTFA-403-E (BACK) REV. 12 (3-18) STATE OF CALIFORNIA INDIVIDUAL FINANCIAL STATEMENT OTHER RECURRING MONTHLY PAYMENTS CREDITOR(S) NAME AND ADDRESS CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION PAYROLL DEDUCT YES NO TYPE: AUTO, PERSONAL LOAN, ETC. ORIGINAL AMOUNT DUE INCURRED DATE BALANCE DUE DATE FINAL PAYMENT WILL BE DUE AMOUNT OF MONTHLY PAYMENT 1. 2. 3. 4. 5. 6. 7. 8. Other – Please use separate sheet 9. Other taxes owed. Please list agencies, year(s) and amounts 10. SUBTOTAL (Add lines 1 thru 9. Enter here and on page 1, line 14) $ VEHICLE INFORMATION (Please include the make, model, year and plate number for autos, trailers, vessels, aircraft, etc.). Do you have a current license/permit with CDTFA? If yes, please list the account number(s): Yes 1. 2. Have you filed bankruptcy in the past year? If yes, list court and case number. Yes No REAL PROPERTY ADDRESS 1. Your proposed terms to satisfy this amount due: Your proposed terms to satisfy this amount due: 2. OTHER PARTNERSHIP(S) / CORPORATION(S) NAME ADDRESS TELEPHONE 1. 2. 3. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Signed Date I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Signed Date CLEAR PRINT No
Extracted from PDF file 2023-california-form-cdtfa-403-e.pdf, last modified March 2018

More about the California Form CDTFA-403-E Other TY 2023

This financial statement form is used when negotiating collection actions / offers in compromise with the California California Department of Tax and Fee Administration. Form CDTFA-403-E requires you to list multiple forms of income, such as wages, interest, or alimony .

We last updated the Individual Financial Statement (California Department of Tax and Fee Administration) in February 2024, so this is the latest version of Form CDTFA-403-E, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form CDTFA-403-E directly from TaxFormFinder. You can print other California tax forms here.

Other California Other Forms:

TaxFormFinder has an additional 174 California income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 593-E Real Estate Withholding - Computation of Estimated Gain or Loss
Form 593-C Real Estate Withholding Certificate
593 Booklet Real Estate Withholding Booklet
Form 593-V Payment Voucher for Real Estate Withholding
Form CDTFA-392 Power of Attorney (CA Department of Tax and Fee Administration)

Download all CA tax forms View all 175 California Income Tax Forms


Form Sources:

California usually releases forms for the current tax year between January and April. We last updated California Form CDTFA-403-E from the Franchise Tax Board in February 2024.

Show Sources >

Historical Past-Year Versions of California Form CDTFA-403-E

We have a total of three past-year versions of Form CDTFA-403-E in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:



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