California California e-file Payment Record for Individuals

California e-file Payment Record for Individuals
2023 Form 8455 California e-file Payment Record for Individuals
DO NOT MAIL THIS FORM TO THE FTB
TAXABLE YEAR

2023

FORM

California e-file Payment Record for Individuals

8455

Your name

Your SSN or ITIN

Spouse’s/RDP’s name

Spouse’s/RDP’s SSN or ITIN

Part I

Tax Return Information (whole dollars only)

1 California adjusted gross income. (Form 540, line 17; Form 540 2EZ, line 16; or Form 540NR, line 32) . . . . . . . . .1
2 Amount you owe. (Form 540, line 111; Form 540 2EZ, line 35; Form 540NR, line 121; or
Schedule X, line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Part II

Return Payment Information for Taxable Year 2023 (pay by 4/15/2024)

3 Electronic funds withdrawal amount
4 Withdrawal date (mm/dd/yyyy)
Part III Scheduled Estimated Tax Payments for Taxable Year 2024 These are NOT installments of the current amount you owe.
First Payment 4/15/2024
Second Payment 6/17/2024
Third Payment 9/16/2024
Fourth Payment 1/15/2025
5 Amount
6 Withdrawal date
Part IV Banking Information for Electronic Funds Withdrawals from Parts II and III
7 Routing number
8 Account number
9 Type of account:

◽ Checking

◽ Savings

General Information
Form FTB 8455, California e-file Payment Record for Individuals, is a summary of electronic funds withdrawals that you have authorized with
your 2023 e-file tax return as part of your California e-file Signature Authorization for Individuals (form FTB 8879). You are to receive a copy of
form FTB 8455 or a comparable form at the time you sign form FTB 8879. Form FTB 8455 does not serve as proof of filing or proof of payment.
Your proof of filing is the acknowledgement containing the date we accepted your tax return. Your proof of payment is your banking records.
Be sure the banking information is correct before transmitting your tax return. If the bank or financial institution rejects the electronic funds
withdrawal due to an error in the routing number or account number, we will send you a notice that may include penalties and interest.
To cancel your tax return payment or an estimated tax payment, you must call FTB e-Programs Customer Service at 916.845.0353 at
least two working days before the scheduled date of the payment.
If you cancel a payment, you are still liable for any amount you owe. Make your payments by the due dates above to avoid a late payment
penalty. For more payment options, go to ftb.ca.gov/pay.
Franchise Tax Board Privacy Notice on Collection
Our privacy notice can be found in annual tax booklets or online. Go to ftb.ca.gov/privacy to learn about our privacy policy statement, or go to
ftb.ca.gov/forms and search for 1131 to locate FTB 1131 EN-SP, Franchise Tax Board Privacy Notice on Collection – Aviso de Privacidad del
Franchise Tax Board sobre la Recaudación. To request this notice by mail, call 800.338.0505 and enter form code 948 when instructed.

KEEP THIS FORM FOR YOUR RECORDS – DO NOT MAIL TO THE FRANCHISE TAX BOARD (FTB)

For Privacy Notice, get FTB 1131 EN-SP.

FTB 8455 2023