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E (Community/Separate) 2 Allocated to Spouse, RDP, or California Same-Sex Spouse SSN - - 3 Allocated to Spouse, RDP, or California Same-Sex Spouse SSN - - 1 Wages (each employer) 2 Interest Income (each payer) 3 Dividends (each payer) 4 State Income Tax Refund 5 Self-Employment Income (See instructions) 6 Capital Gains and Losses 7 Pension Income 8 Rents, Royalties, Partnerships, Estates, Trusts For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37779G.

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