3504: Enrolled Tribal Member Certification (2024)
California · FTB · Used for tax years 2024
California Form 3504 certifies an enrolled tribal member's tribal membership and reservation residency. It records exempt income sources and amounts, residency verification by an authorized tribal government representative, and information about residential property owned outside
What you'll need
Have the following information ready for the 2024 form:
- Your name, Social Security number, mailing address, and physical address.
- Your tribe's name and your tribal enrollment number.
- The reservation or reservations where you lived during the tax year and your dates of residency.
- For each exempt income source: the employer's name or income source, the physical address where you worked if applicable, the income type, and the amount qualifying as exempt.
- If you own residential property outside the boundaries of California Indian country: each property's physical address, use, occupants, and dates you lived there, if applicable.
If you live on a reservation of a tribe other than the tribe in which you are enrolled, attach a copy of your tribal enrollment card.
Part II requires residency verification and a signature from an authorized tribal government representative who is on file with the Franchise Tax Board.
Common mistakes
- Do not use a PO box for your physical address.
- Do not omit the tribal enrollment card copy if you live on a reservation of a tribe other than your enrolled tribe.
- Make sure the person verifying your residency has authority from the Tribal Chairperson and/or Tribal Council and is on file with the Franchise Tax Board.
- Do not overlook Part IV if you own residential property outside the boundaries of California Indian country.
- Check the exemption requirements before listing income as exempt. Part III directs you to the General Information section of the form instructions.
Questions people ask
Who can verify my reservation residency?
A designated person within the tribal government must verify it. That person must have authority from the Tribal Chairperson and/or Tribal Council, be on file with the Franchise Tax Board, and declare your residency based on personal knowledge.
When do I need to attach my tribal enrollment card?
Attach a copy if you live on a reservation of a tribe other than the tribe in which you are enrolled.
What income details does Part III request?
It asks for the employer's name or income source, the physical address where you worked if applicable, the income type, and the amount qualifying as exempt income. For exemption requirements, the form refers you to the General Information section of its instructions.
Do I need to list residential property outside California Indian country?
Yes, if you own it. Part IV asks for the property's physical address, its use, who lived there, and the dates you lived there, if applicable.
Do I need to sign the form?
Yes. The form asks for your printed name, signature, and date beneath a declaration that the information on and included with the form is true, correct, and complete under penalty of perjury under California law.