1040 U.S.

Individual Income Tax Return 2022

Form Department of the Treasury—Internal Revenue Service

OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space.

Filing Status Single Married filing jointly Married filing separately (MFS) Head of household (HOH)
Qualifying surviving
Check only spouse (QSS)
one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child’s name if the qualifying
person is a child but not your dependent:
Your first name and middle initial Last name Your social security number
Michael D Atchue 563-89-6847
If joint return, spouse’s first name and middle initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
275 Esperanza Ave 403 Check here if you, or your
spouse if filing jointly, want $3
City, town, or post office. If you have a foreign address, also complete spaces below. State ZIP code
to go to this fund. Checking a
Long Beach CA 908023655 box below will not change
Foreign country name Foreign province/state/county Foreign postal code your tax or refund.
You Spouse

Digital At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell,
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Yes No
Standard Someone can claim: You as a dependent Your spouse as a dependent
Deduction Spouse itemizes on a separate return or you were a dual-status alien

Age/Blindness You: Were born before January 2, 1958 Are blind Spouse: Was born before January 2, 1958 Is blind
Dependents (see instructions): (2) Social security (3) Relationship (4) Check the box if qualifies for (see instructions):
(1) First name Last name number to you Child tax credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here . .

Income 1a Total amount from Form(s) W-2, box 1 (see instructions) . . . . . . . . . . . . . 1a 106,700.
b Household employee wages not reported on Form(s) W-2 . . . . . . . . . . . . . 1b
Attach Form(s) c Tip income not reported on line 1a (see instructions) . . . . . . . . . . . . . . 1c
W-2 here. Also
attach Forms d Medicaid waiver payments not reported on Form(s) W-2 (see instructions) . . . . . . . . 1d
W-2G and e Taxable dependent care benefits from Form 2441, line 26 . . . . . . . . . . . . 1e
1099-R if tax
was withheld. f Employer-provided adoption benefits from Form 8839, line 29 . . . . . . . . . . . 1f
If you did not g Wages from Form 8919, line 6 . . . . . . . . . . . . . . . . . . . . . 1g
get a Form h Other earned income (see instructions) . . . . . . . . . . . . . . . . . . 1h 0.
W-2, see
instructions.
i Nontaxable combat pay election (see instructions) . . . . . . . 1i
z Add lines 1a through 1h . . . . . . . . . . . . . . . . . . . . . . 1z 106,700.
Attach Sch. B 2a Tax-exempt interest . . . 2a b Taxable interest . . . . . 2b
if required. 3a Qualified dividends . . . 3a b Ordinary dividends . . . . . 3b
4a IRA distributions . . . . 4a b Taxable amount . . . . . . 4b
Standard 5a Pensions and annuities . . 5a b Taxable amount . . . . . . 5b
Deduction for—
6a Social security benefits . . 6a b Taxable amount . . . . . . 6b
• Single or
Married filing c If you elect to use the lump-sum election method, check here (see instructions) . . . . .
separately,
$12,950 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here . . . . . 7
• Married filing 8 Other income from Schedule 1, line 10 . . . . . . . . . . . . . . . . . . 8
jointly or
Qualifying 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income . . . . . . . . . . 9 106,700.
surviving spouse,
$25,900
10 Adjustments to income from Schedule 1, line 26 . . . . . . . . . . . . . . . 10
• Head of 11 Subtract line 10 from line 9. This is your adjusted gross income . . . . . . . . . . 11 106,700.
household,
$19,400 12 Standard deduction or itemized deductions (from Schedule A) . . . . . . . . . . 12 12,950.
• If you checked 13 Qualified business income deduction from Form 8995 or Form 8995-A . . . . . . . . . 13
any box under
Standard 14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . 14 12,950.
Deduction, 15 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income . . . . .
see instructions.
15 93,750.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Form 1040 (2022)
Form 1040 (2022) Page 2

Tax and 16 Tax (see instructions). Check if any from Form(s): 1 8814 2 4972 3 . . 16 16,342.
Credits 17 Amount from Schedule 2, line 3 . . . . . . . . . . . . . . . . . . . . 17
18 Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . . . . . . 18 16,342.
19 Child tax credit or credit for other dependents from Schedule 8812 . . . . . . . . . . 19
20 Amount from Schedule 3, line 8 . . . . . . . . . . . . . . . . . . . . 20
21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . 21
22 Subtract line 21 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . 22 16,342.
23 Other taxes, including self-employment tax, from Schedule 2, line 21 . . . . . . . . . 23 0.
24 Add lines 22 and 23. This is your total tax . . . . . . . . . . . . . . . . . 24 16,342.
Payments 25 Federal income tax withheld from:
a Form(s) W-2 . . . . . . . . . . . . . . . . . . 25a 16,421.
b Form(s) 1099 . . . . . . . . . . . . . . . . . . 25b
c Other forms (see instructions) . . . . . . . . . . . . . 25c
d Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . 25d 16,421.
26 2022 estimated tax payments and amount applied from 2021 return . . . . . . . . . . 26
If you have a
qualifying child, 27 Earned income credit (EIC) . . . . . . . . . . . . . . 27
attach Sch. EIC.
28 Additional child tax credit from Schedule 8812 . . . . . . . . 28
29 American opportunity credit from Form 8863, line 8 . . . . . . . 29
30 Reserved for future use . . . . . . . . . . . . . . . 30
31 Amount from Schedule 3, line 15 . . . . . . . . . . . . 31
32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits . . 32
33 Add lines 25d, 26, and 32. These are your total payments . . . . . . . . . . . . 33 16,421.
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid . . 34 79.
Refund
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . 35a 79.
Direct deposit? b Routing number 3 2 2 2 7 4 2 4 2 c Type: Checking Savings
See instructions.
d Account number 1 0 8 0 0 0 0 1 8 1 5 0 4
36 Amount of line 34 you want applied to your 2023 estimated tax . . . 36
Amount 37 Subtract line 33 from line 24. This is the amount you owe.
You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions . . . . . . . . 37
38 Estimated tax penalty (see instructions) . . . . . . . . . . 38
Third Party Do you want to allow another person to discuss this return with the IRS? See
Designee instructions . . . . . . . . . . . . . . . . . . . . . Yes. Complete below. No
Designee’s Phone Personal identification
name no. number (PIN)
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation If the IRS sent you an Identity
Protection PIN, enter it here
Joint return? Communications Manager (see inst.)
See instructions. Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an
Keep a copy for Identity Protection PIN, enter it here
your records. (see inst.)

Phone no. (714)613-2072 Email address

Preparer’s name Preparer’s signature Date PTIN Check if:
Paid Self-employed
Preparer
Firm’s name Self-Prepared Phone no.
Use Only
Firm’s address Firm’s EIN
Go to www.irs.gov/Form1040 for instructions and the latest information. BAA REV 02/05/23 Intuit.cg.cfp.sp Form 1040 (2022)

No
175
Date Accepted DO NOT MAIL THIS FORM TO THE FTB
TAXABLE YEAR California Online e-file Return Authorization FORM

2022 for Individuals 8453-OL

Your first name and initial Last name Suffix Your SSN or I T I N
MICHAEL D ATCHUE 563-89-6847
If filing jointly, spouse’s/RDP’s first name and initial Last name Suffix Spouse’s/RDP’s SSN or ITIN

Street address (number and street) or PO box Apt. no./ste. no. PMB/private mailbox Daytime telephone number
275 ESPERANZA AVE APT 403 (714)613-2072
City State ZIP code
LONG BEACH CA 90802-3655
Foreign country name Foreign province/state/county Foreign postal code

Part I Tax Return Information (whole dollars only)

1 California adjusted gross income. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 106700
2 Refund or no amount due. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 939
3 Amount you owe. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Part II Settle Your Account Electronically for Taxable Year 2022 (Pay by 4/18/2023)
4 □ Direct deposit of refund
5 □ Electronic funds withdrawal 5a Amount 5b Withdrawal date (mm/dd/yyyy)
Part III Make Estimated Tax Payments for Taxable Year 2023 These are NOT installment payments for the current amount you owe.
First Payment Second Payment Third Payment Fourth Payment
4/18/2023 6/15/2023 9/15/2023 1/16/2024
6 Amount
7 Withdrawal date
Part IV Banking Information (Have you verified your banking information?)
8 Amount of refund to be directly deposited 12 The remaining amount of my refund
to account below 939 for direct deposit
9 Routing number 322274242 13 Routing number
10 Account number 1080000181504 14 Account number
11 Type of account: □ Checking □ Savings 15 Type of account: □ Checking □ Savings
Part V Declaration of Taxpayer(s)
I authorize my account to be settled as designated in Part II. If I check Part II, box 4, I declare that the direct deposit refund information in
Part IV agrees with the authorization stated on my return. If I check Part II, box 5, I authorize an electronic funds withdrawal for the amount
listed on line 5a and any estimated payment amounts listed on line 6 from the bank account listed on lines 9, 10, and 11. If I have filed a
joint return, this is an irrevocable appointment of the other spouse/registered domestic partner (RDP) as an agent to receive the refund or
authorize an electronic funds withdrawal.
Under penalties of perjury, I declare that the information I provided to the Franchise Tax Board (FTB), either directly or through e-file
software, including my name, address, and social security number (SSN) or individual taxpayer identification number (ITIN), and the
amounts shown in Part I above, agrees with the information and amounts shown on the corresponding lines of my 2022 California income
tax return. To the best of my knowledge and belief, my return is true, correct, and complete. If I am filing a balance due return, I understand
that if the FTB does not receive full and timely payment of my tax liability, I remain liable for the tax liability and all applicable interest and
penalties. I authorize my return and accompanying schedules and statements to be transmitted to the FTB directly or through the e-file
software. If the processing of my return or refund is delayed, I authorize the FTB to disclose to me, either directly or through the e-file
software, the reason(s) for the delay or the date when the refund was sent.

Sign Your signature Date

Here

Spouse’s/RDP’s signature. If filing jointly, both must sign. Date

It is unlawful to forge a spouse’s/RDP’s signature.

For Privacy Notice, get FTB 1131 EN-SP. REV 02/03/23 INTUIT.CG.CFP.SP FTB 8453-OL 2022
 TAXABLE YEAR FORM

2022 California Resident Income Tax Return 540

APE DO NOT ATTACH FEDERAL RETURN
563-89-6847 ATCH 22
MICHAEL D ATCHUE

275 ESPERANZA AVE APT 403

LONG BEACH CA 90802-3655

05-19-1986

Enter your county at time of filing (see instructions)

LOS ANGELES
Principal Residence

If your address above is the same as your principal/physical residence address at the time of filing, check this box . . .
If not, enter below your principal/physical residence address at the time of filing.
Street address (number and street) (If foreign address, see instructions.) Apt. no/ste. no.

City State ZIP code

If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . .

1 Single 4 Head of household (with qualifying person). See instructions.

Filing Status

2 Married/RDP filing jointly. See instr. 5 Qualifying surviving spouse/RDP. Enter year spouse/RDP died.

See instructions.

3 Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here.

6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See instr. . . . . . . ● 6

▶ For line 7, line 8, line 9, and line 10: Multiply the number you enter in the box by the pre-printed dollar amount for that line.
Whole dollars only
7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked
Exemptions

box 2 or 5, enter 2 in the box. If you checked the box on line 6, see instructions. 7 1 X $140 = ● $ 140
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
if both are visually impaired, enter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X $140 = $
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1;
if both are 65 or older, enter 2. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . ●9 X $140 = $
REV 02/03/23 INTUIT.CG.CFP.SP

175 3101224 Form 540 2022 Side 1

Your name: ATCHUE Your SSN or ITIN: 563-89-6847
10 Dependents: Do not include yourself or your spouse/RDP.
Dependent 1 Dependent 2 Dependent 3
First Name

Last Name
Exemptions

SSN. See
instructions. ● ● ●
Dependent’s
relationship
to you

Total dependent exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 10 X $433 = $

11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . . . . . . . . . . . . . 11 $ 140

12 State wages from your federal

Form(s) W-2, box 16 . . . . . . . . . . . . . . . . . . . . . . ● 12 106700 . 00

13 Enter federal adjusted gross income from federal Form 1040 or 1040-SR, line 11 . . . . . . . . 13 106700 . 00
14 California adjustments – subtractions. Enter the amount from Schedule CA (540),
Part I, line 27, column B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 14 . 00
15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses.
106700 . 00
Taxable Income

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 California adjustments – additions. Enter the amount from Schedule CA (540),
Part I, line 27, column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 16 . 00

17 California adjusted gross income. Combine line 15 and line 16 . . . . . . . . . . . . . . . . . . . . . . . ● 17 106700 . 00

{ {
18 Enter the Your California itemized deductions from Schedule CA (540), Part II, line 30; OR
larger of Your California standard deduction shown below for your filing status:
• Single or Married/RDP filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,202
• Married/RDP filing jointly, Head of household, or Qualifying surviving spouse/RDP. $10,404
If Married/RDP filing separately or the box on line 6 is checked, STOP. See instructions ● 18
5202 . 00
19 Subtract line 18 from line 17. This is your taxable income.
If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 101498 . 00

Tax Table Tax Rate Schedule

31 Tax. Check the box if from:
● FTB 3800 ● FTB 3803 . . . . . . . . . . . . . . . . ● 31 6193 . 00
32 Exemption credits. Enter the amount from line 11. If your federal AGI is more than
$229,908, see instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 140 . 00
Tax

33 Subtract line 32 from line 31. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 6053 . 00

34 Tax. See instructions. Check the box if from: ● Schedule G-1 ● FTB 5870A . . ● 34 . 00

35 Add line 33 and line 34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 6053 . 00

●
Special Credits

40 Nonrefundable Child and Dependent Care Expenses Credit. See instructions. . . . . . . . . . . . . 40 . 00

43 Enter credit name code ● and amount. . . ● 43 . 00

44 Enter credit name code ● and amount. . . ● 44 . 00

REV 02/03/23 INTUIT.CG.CFP.SP

Side 2 Form 540 2022 175 3102224

 Your name: ATCHUE Your SSN or ITIN: 563-89-6847

45 To claim more than two credits. See instructions. Attach Schedule P (540). . . . . . . . . . . . . . ● 45 . 00
Special Credits

46 Nonrefundable Renter’s Credit. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 46 . 00

47 Add line 40 through line 46. These are your total credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 . 00

48 Subtract line 47 from line 35. If less than zero, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 6053 . 00

61 Alternative Minimum Tax. Attach Schedule P (540) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 61 . 00

Other Taxes

62 Mental Health Services Tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 62 . 00

63 Other taxes and credit recapture. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 63 . 00

64 Add line 48, line 61, line 62, and line 63. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . ● 64 6053 . 00

71 California income tax withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 71 6992 . 00

72 2022 California estimated tax and other payments. See instructions . . . . . . . . . . . . . . . . . . . ● 72 . 00

73 Withholding (Form 592-B and/or Form 593). See instructions. . . . . . . . . . . . . . . . . . . . . . . . ● 73 . 00

Payments

74 Excess SDI (or VPDI) withheld. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 74 . 00

75 Earned Income Tax Credit (EITC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 75 . 00

76 Young Child Tax Credit (YCTC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 76 . 00

77 Foster Youth Tax Credit (FYTC). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 77 . 00

78 Add line 71 through line 77. These are your total payments.
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6992 . 00

●
Use Tax

91 Use Tax. Do not leave blank. See instructions . . . . . . . . . . . . . . . . . . . . . . 91 0 . 00

If line 91 is zero, check if: No use tax is owed. You paid your use tax obligation directly to CDTFA.

92 If you and your household had full-year health care coverage, check the box.
●
Penalty

See instructions. Medicare Part A or C coverage is qualifying health care coverage. . . . . . . .

ISR

If you did not check the box, see instructions.

Individual Shared Responsibility (ISR) Penalty. See instructions . . . . . . . . ● 92 . 00

93 Payments balance. If line 78 is more than line 91, subtract line 91 from line 78 . . . . . . . . . . 93 6992 . 00
Overpaid Tax/Tax Due

94 Use Tax balance. If line 91 is more than line 78, subtract line 78 from line 91 . . . . . . . . . . . 94 . 00
95 Payments after Individual Shared Responsibility Penalty. If line 93 is more than line 92,
subtract line 92 from line 93. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 6992 . 00
96 Individual Shared Responsibility Penalty Balance. If line 92 is more than line 93,
subtract line 93 from line 92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 . 00

97 Overpaid tax. If line 95 is more than line 64, subtract line 64 from line 95. . . . . . . . . . . . . . . 97 939 . 00
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175 3103224 Form 540 2022 Side 3

Your name: ATCHUE Your SSN or ITIN: 563-89-6847

98 Amount of line 97 you want applied to your 2023 estimated tax . . . . . . . . . . . . . . . . . . . . . . ● 98 . 00

Tax/Tax Due
Overpaid

99 Overpaid tax available this year. Subtract line 98 from line 97 . . . . . . . . . . . . . . . . . . . . . . . . ● 99 939 . 00

100 Tax due. If line 95 is less than line 64, subtract line 95 from line 64 . . . . . . . . . . . . . . . . . . . 100 . 00
Code Amount

California Seniors Special Fund. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 400 . 00

Alzheimer’s Disease and Related Dementia Voluntary Tax Contribution Fund . . . . . . . . . . . . . ● 401 . 00

Rare and Endangered Species Preservation Voluntary Tax Contribution Program . . . . . . . . . ● 403 . 00

California Breast Cancer Research Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . ● 405 . 00

California Firefighters’ Memorial Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . ● 406 . 00

Emergency Food for Families Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . ● 407 . 00

California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund. . . . . . . . . . . ● 408 . 00

California Sea Otter Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 410 . 00

California Cancer Research Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . ● 413 . 00

Contributions

School Supplies for Homeless Children Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . ● 422 . 00

State Parks Protection Fund/Parks Pass Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 423 . 00

Protect Our Coast and Oceans Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . . ● 424 . 00

Keep Arts in Schools Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 425 . 00

Prevention of Animal Homelessness and Cruelty Voluntary Tax Contribution Fund . . . . . . . . ● 431 . 00

California Senior Citizen Advocacy Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . ● 438 . 00

Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . ● 439 . 00

Rape Kit Backlog Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 440 . 00

Suicide Prevention Voluntary Tax Contribution Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● 444 . 00

Mental Health Crisis Prevention Voluntary Tax Contribution Fund. . . . . . . . . . . . . . . . . . . . . . ● 445 . 00

California Community and Neighborhood Tree Voluntary Tax Contribution Fund . . . . . . . . . . ● 446 . 00

110 Add amounts in code 400 through code 446. This is your total contribution . . . . . . . . . . . . . ● 110 . 00
You Owe
Amount

111 AMOUNT YOU OWE. If you do not have an amount on line 99, add line 94, line 96, line 100, and line 110. See instructions. Do not send cash.
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001. . . . . ● 111 . 00
Pay Online – Go to ftb.ca.gov/pay for more information.
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Side 4 Form 540 2022 175 3104224

Your name: ATCHUE Your SSN or ITIN: 563-89-6847

112 Interest, late return penalties, and late payment penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 . 00
Interest and
Penalties

113 Underpayment of estimated tax.

Check the box: ● FTB 5805 attached ● FTB 5805F attached . . . . . . . . . . . ● 113 . 00

114 Total amount due. See instructions. Enclose, but do not staple, any payment . . . . . . . . . . . . 114 . 00
115 REFUND OR NO AMOUNT DUE. Subtract the sum of line 110, line 112, and line 113 from line 99. See instructions.

Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0001. . . . . . . ● 115 939 . 00

Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip.
Refund and Direct Deposit

See instructions. Have you verified the routing and account numbers? Use whole dollars only.
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
● Type
● Routing number Checking ● Account number ● 116 Direct deposit amount
322274242 1080000181504 939 . 00
Savings

The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
● Type
● Routing number Checking ● Account number ● 117 Direct deposit amount

. 00
Savings
Voter
Info.

For voter registration information, check the box and go to sos.ca.gov/elections. See instructions . . . . . . . . . . . . . . . .
IMPORTANT: See the instructions to find out if you should attach a copy of your complete federal tax return.
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. To request this notice by mail, call 800.338.0505 and enter form code 948 when instructed.
Under penalties of perjury, I declare that I have examined this tax return, including accompanying schedules and statements, and to the best of my knowledge and belief, it
is true, correct, and complete.
Your signature Date Spouse’s/RDP’s signature (if a joint tax return, both must sign)

Your email address. Enter only one email address. Preferred phone number

7146132072
Sign
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Here SELF-PREPARED
It is unlawful
to forge a
spouse’s/
Firm’s name (or yours, if self-employed) ● PTIN
RDP’s
signature.
Firm’s address ● Firm’s FEIN
Joint tax
return?
See
instructions.
Do you want to allow another person to discuss this tax return with us? See instructions . . . . . . . ● Yes No
Print Third Party Designee’s Name Telephone Number

REV 02/03/23 INTUIT.CG.CFP.SP

175 3105224 Form 540 2022 Side 5

 TAXABLE YEAR SCHEDULE

2022 California Adjustments — Residents CA (540)

Important: Attach this schedule behind Form 540, Side 5 as a supporting California schedule.
Name(s) as shown on tax return SSN or ITIN

MICHAEL D ATCHUE 563896847

Part I Income Adjustment Schedule Federal Amounts Subtractions Additions
Section A – Income from federal Form 1040 or 1040-SR
A (taxable amounts from your
federal tax return)
B See instructions C See instructions

1 a Total amount from federal

Form(s) W-2, box 1. See instructions . . . . . . . 1a 106700
b Household employee wages not reported
on federal Form(s) W-2 . . . . . . . . . . . . . . . . . . 1b

c Tip income not reported on line 1a . . . . . . . . . 1c

d Medicaid waiver payments not reported
on federal Form(s) W-2. See instructions . . . . 1d
e Taxable dependent care benefits
from federal Form 2441, line 26 . . . . . . . . . . . 1e
f Employer-provided adoption benefits
from federal Form 8839, line 29 . . . . . . . . . . . 1f

g Wages from federal Form 8919, line 6. . . . . . . 1g

h Other earned income. See instructions . . . . . . 1h 0

i Nontaxable combat
pay election. See instructions . . . . . . . . . . . . . 1i

z Add line 1a through line 1i. . . . . . . . . . . . . . . . 1z 106700

2 Taxable interest. a 2b
3 Ordinary dividends.
See instructions. a 3b
4 IRA distributions.
See instructions. a 4b
5 Pensions and
annuities. See
instructions. a 5b
6 Social security
benefits. a 6b

7 Capital gain or (loss). See instructions . . . . . . . . 7

Section B – Additional Income from federal Schedule 1 (Form 1040)
1 Taxable refunds, credits, or offsets of state
and local income taxes . . . . . . . . . . . . . . . . . . . . .1

2 a Alimony received. See instructions. . . . . . . . . 2a

3 Business income or (loss). See instructions. . . . .3

4 Other gains or (losses) . . . . . . . . . . . . . . . . . . . . .4

5 Rental real estate, royalties, partnerships,
S corporations, trusts, etc. . . . . . . . . . . . . . . . . . .5

6 Farm income or (loss) . . . . . . . . . . . . . . . . . . . . .6

7 Unemployment compensation . . . . . . . . . . . . . . .7
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For Privacy Notice, get FTB 1131 EN-SP. 175 7731224 Schedule CA (540) 2022 Side 1
Section B – Additional Income Federal Amounts Subtractions Additions
Continued A (taxable amounts from your B See instructions C See instructions
federal tax return)
8 Other income:
a Federal net operating loss . . . . . . . . . . . . . . . . .8a ( )

b Gambling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8b

c Cancellation of debt . . . . . . . . . . . . . . . . . . . . . 8c
d Foreign earned income exclusion from
federal Form 2555 . . . . . . . . . . . . . . . . . . . . . . 8d ( )

e Income from federal Form 8853 . . . . . . . . . . . 8e

f Income from federal Form 8889. . . . . . . . . . . . 8f

g Alaska Permanent Fund dividends . . . . . . . . . . 8g

h Jury duty pay. . . . . . . . . . . . . . . . . . . . . . . . . . 8h

i Prizes and awards . . . . . . . . . . . . . . . . . . . . . . 8i

j Activity not engaged in for profit income . . . . . 8j

k Stock options. . . . . . . . . . . . . . . . . . . . . . . . . . 8k

l Income from the rental of personal property

if you engaged in the rental for profit but were
not in the business of renting such property . . 8l
m Olympic and Paralympic medals and USOC
prize money. . . . . . . . . . . . . . . . . . . . . . . . . . . 8m

n IRC Section 951(a) inclusion . . . . . . . . . . . . . . 8n

o IRC Section 951A(a) inclusion. . . . . . . . . . . . . 8o

p IRC Section 461(l) excess business loss adjustment 8p

q Taxable distributions from an ABLE account . . 8q

r Scholarship and fellowship grants
not reported on federal Form(s) W-2 . . . . . . . . 8r
s Nontaxable amount of Medicaid waiver payments
included on federal Form 1040, line 1a or line 1d. .8s ( )

t Pension or annuity from a nonqualified

deferred compensation plan or a
nongovernmental IRC Section 457 plan . . . . . . 8t

u Wages earned while incarcerated. . . . . . . . . . . 8u

z Other income. List type and amount.
8z
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Side 2 Schedule CA (540) 2022 175 7732224

Section B – Additional Income Federal Amounts Subtractions Additions
Continued A (taxable amounts from your B See instructions C See instructions
federal tax return)

9 a Total other income. Add lines 8a through 8z. 9a

b1 Disaster loss deduction from form FTB 3805V.. 9b1

b2 NOL deduction from form FTB 3805V . . . . . . 9b2

b3 NOL from form FTB 3805Z, 3807, or 3809 . . 9b3

10 Total. Combine Section A, line 1z through line 7,

and Section B, line 1 through line 7, and line 9a
in column A and column C. Add Section A, line 1z
through line 7, and Section B, line 1 through line 7,
line 9a, and line 9b1 through line 9b3 in column B
(as applicable). See instructions. . . . . . . . . . . . . . . .10 106700
Section C – Adjustments to Income
from federal Schedule 1 (Form 1040)

11 Educator expenses . . . . . . . . . . . . . . . . . . . . . . .11

12 Certain business expenses of reservists, performing
artists, and fee-basis government officials. . . . . . .12

13 Health savings account deduction . . . . . . . . . . .13

14 Moving expenses. Attach form FTB 3913.
See instructions . . . . . . . . . . . . . . . . . . . . . . . . .14
15 Deductible part of self-employment tax.
See instructions. . . . . . . . . . . . . . . . . . . . . . . . .15

16 Self-employed SEP, SIMPLE, and qualified plans. .16

17 Self-employed health insurance deduction.
See instructions. . . . . . . . . . . . . . . . . . . . . . . . .17

18 Penalty on early withdrawal of savings . . . . . . . . 18

19 a Alimony paid. . . . . . . . . . . . . . . . . . . . . . . . .19a

b Recipient’s: SSN

Last Name

20 IRA deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Student loan interest deduction . . . . . . . . . . . . . . 21

22 Reserved for future use . . . . . . . . . . . . . . . . . . . . 22

23 Archer MSA deduction. . . . . . . . . . . . . . . . . . . . . 23

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175 7733224 Schedule CA (540) 2022 Side 3

Section C – Adjustments to Income Federal Amounts Subtractions Additions
Continued A (taxable amounts from your B See instructions C See instructions
federal tax return)
24 Other adjustments:
a Jury duty pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24a
b Deductible expenses related to income reported
on line 8l from the rental of personal property
engaged in for profit. . . . . . . . . . . . . . . . . . . . . . . 24b
c Nontaxable amount of the value of Olympic and
Paralympic medals and USOC prize money
reported on line 8m . . . . . . . . . . . . . . . . . . . . . . . 24c

d Reforestation amortization and expenses. . . . . . . 24d

e Repayment of supplemental unemployment
benefits under the federal Trade Act of 1974 . . . . 24e
f Contributions to IRC Section 501(c)(18)(D)
pension plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24f
g Contributions by certain chaplains to
IRC Section 403(b) plans . . . . . . . . . . . . . . . . . . . 24g
h Attorney fees and court costs for actions involving
certain unlawful discrimination claims . . . . . . . . . 24h
i Attorney fees and court costs you paid in connection
with an award from the IRS for information you provided
that helped the IRS detect tax law violations. . . . . . . 24i

j Housing deduction from federal Form 2555 . . . . . 24j

k Excess deductions of IRC Section 67(e) expenses
from federal Schedule K-1 (Form 1041) . . . . . . . . 24k
z Other adjustments. List type and amount.

24z
25 Total other adjustments. Add line 24a through
line 24z . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
26 Add line 11 through line 23 and line 25 in
columns A, B, and C. See instructions . . . . . . . . . . . 26
27 Total. Subtract line 26 from line 10 in
columns A, B, and C. See instructions . . . . . . . . . . . 27
106700
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Side 4 Schedule CA (540) 2022 175 7734224

Part II Adjustments to Federal Itemized Deductions

Check the box if you did NOT itemize for federal but will itemize for California . . . . . . . . . . .
Federal Amounts Subtractions Additions
A (from federal Schedule A B See instructions C See instructions
(Form 1040))
Medical and Dental Expenses See instructions.
1 Medical and
dental expenses . . . . 1
2 Enter amount from
federal Form 1040
or 1040-SR, line 11. . 106700 2
3 Multiply line 2
by 7.5% (0.075) . . . . 8003 3
4 Subtract line 3 from line 1.
If line 3 is more than line 1, enter 0 . . . . . . . . . . . . . .4
Taxes You Paid
5 a State and local income tax or general sales taxes. .5a 8223 8223

b State and local real estate taxes . . . . . . . . . . . . . . .5b

c State and local personal property taxes . . . . . . . . .5c 0

d Add line 5a through line 5c. . . . . . . . . . . . . . . . . . .5d 8223

e Enter the smaller of line 5d or $10,000 ($5,000 if

married filing separately) in column A.
Enter the amount from line 5a, column B
in line 5e, column B.
Enter the difference from line 5d and line 5e,
column A in line 5e, column C . . . . . . . . . . . . . . . .5e 8223 8223 0

6 Other taxes. List type 6

7 Add line 5e and line 6 . . . . . . . . . . . . . . . . . . . . . . . . .7 8223 8223 0

Interest You Paid
8 a Home mortgage interest and points reported to
you on federal Form 1098 . . . . . . . . . . . . . . . . . . .8a
b Home mortgage interest not reported to you
on federal Form 1098 . . . . . . . . . . . . . . . . . . . . . . .8b

c Points not reported to you on federal Form 1098. .8c

d Reserved for future use . . . . . . . . . . . . . . . . . . . . .8d

e Add line 8a through line 8c. . . . . . . . . . . . . . . . . . .8e

9 Investment interest. . . . . . . . . . . . . . . . . . . . . . . . . . .9

10 Add line 8e and line 9 . . . . . . . . . . . . . . . . . . . . . . . .10

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175 7735224 Schedule CA (540) 2022 Side 5

Part II Adjustments to Federal Itemized Deductions Federal Amounts Subtractions Additions
Continued A (from federal Schedule A B See instructions C See instructions
(Form 1040))
Gifts to Charity
11 Gifts by cash or check. . . . . . . . . . . . . . . . . . . . . . . .11

12 Other than by cash or check. . . . . . . . . . . . . . . . . . .12

13 Carryover from prior year. . . . . . . . . . . . . . . . . . . . .13

14 Add line 11 through line 13 . . . . . . . . . . . . . . . . . . .14

Casualty and Theft Losses
15 Casualty or theft loss(es) (other than net qualified disaster
losses). Attach federal Form 4684. See instructions . .15

Other Itemized Deductions

16 Other—from list in federal instructions.. . . . . . . . . .16
17 Add lines 4, 7, 10, 14, 15, and 16 in
columns A, B, and C. . . . . . . . . . . . . . . . . . . . . . . . .17 8223 8223 0

18 Total. Combine line 17 column A less column B plus column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 0

Job Expenses and Certain Miscellaneous Deductions

19 Unreimbursed employee expenses: job travel, union dues, job education, etc.
Attach federal Form 2106 if required. See instructions . . . . . . . . . . . . . . . . . . . . . . . 19

20 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Other expenses: investment, safe deposit
box, etc. List type . . . . . . . . . . . . . . . . . . . . . . 21 0

22 Add line 19 through line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 0

23 Enter amount from federal Form 1040
or 1040-SR, line 11 . . . . . . . . . . . . . . . . . . . . 106700

24 Multiply line 23 by 2% (0.02). If less than zero, enter 0. . . . . . . . . . . . . . . . . . . . . . . 24 2134

25 Subtract line 24 from line 22. If line 24 is more than line 22, enter 0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 0

26 Total Itemized Deductions. Add line 18 and line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 0

27 Other adjustments. See instructions. Specify. 27

28 Combine line 26 and line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 0

29 Is your federal AGI (Form 540, line 13) more than the amount shown below for your filing status?
Single or married/RDP filing separately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $229,908
Head of household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $344,867
Married/RDP filing jointly or qualifying surviving spouse/RDP . . . . . . . . . . . . . . . . $459,821
No. Transfer the amount on line 28 to line 29.
Yes. Complete the Itemized Deductions Worksheet in the instructions for Schedule CA (540), line 29 . . . . . . . . . . . 29 0
30 Enter the larger of the amount on line 29 or your standard deduction listed below:
Single or married/RDP filing separately. See instructions . . . . . . . . . . . . . . . . . . . . . $5,202
Married/RDP filing jointly, head of household, or qualifying surviving spouse/RDP . . $10,404
Transfer the amount on line 30 to Form 540, line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 5202
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Side 6 Schedule CA (540) 2022 175 7736224