Form 590 - Withholding Exemption Certificate Template
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Withholding Exemption Certificate
CALIFORNIA FORM
20
590
(This form can only be used to certify exemption from nonresident withholding under California
R&TC Section 18662. This form cannot be used for exemption from wage withholding.)
Withholding agent’s name
File this form with your withholding agent.
COUNTY OF MONTEREY
(Please type or print)
Vendor/Payee’s name
Vendor/Payee’s
Social security number
Note:
SOS no.
California corp. no.
FEIN
Failure to furnish your
identification number will
make this certificate void.
Vendor/Payee’s address (number and street)
APT no.
Private Mailbox no.
Vendor/Payee’s daytime telephone no.
(
)
City
State
ZIP Code
I certify that for the reasons checked below, the entity or individual named on this form is exempt from the California income tax
withholding requirement on payment(s) made to the entity or individual. Read the following carefully and check the box that applies to
the vendor/payee:
Individuals — Certification of Residency:
I am a resident of California and I reside at the address shown above. If I become a nonresident at any time, I will promptly
inform the withholding agent. See instructions for Form 590, General Information D, for the definition of a resident.
Corporations:
The above-named corporation has a permanent place of business in California at the address shown above or is qualified
through the California Secretary of State to do business in California. The corporation will withhold on payments of California
source income to nonresidents when required. If this corporation ceases to have a permanent place of business in California
or ceases to be qualified to do business in California, I will promptly inform the withholding agent. See instructions for
Form 590, General Information E, for the definition of permanent place of business.
Partnerships:
The above-named partnership has a permanent place of business in California at the address shown above or is registered
with the California Secretary of State, and is subject to the laws of California. The partnership will file a California tax return
and will withhold on foreign and domestic nonresident partners when required. If the partnership ceases to do any of the
above, I will promptly inform the withholding agent. Note: For withholding purposes, a Limited Liability Partnership is treated
like any other partnership.
Limited Liability Companies (LLC):
The above-named LLC has a permanent place of business in California at the address shown above or is registered with the
California Secretary of State, and is subject to the laws of California. The LLC will file a California tax return and will withhold
on foreign and domestic nonresident members when required. If the LLC ceases to do any of the above, I will promptly
inform the withholding agent.
Tax-Exempt Entities:
The above-named entity is exempt from tax under California or federal law. The tax-exempt entity will withhold on payments
of California source income to nonresidents when required. If this entity ceases to be exempt from tax, I will promptly inform
the withholding agent.
Insurance Companies, IRAs, or Qualified Pension/Profit Sharing Plans:
The above-named entity is an insurance company, IRA, or a federally qualified pension or profit-sharing plan.
California Irrevocable Trusts:
At least one trustee of the above-named irrevocable trust is a California resident. The trust will file a California fiduciary tax
return and will withhold on foreign and domestic nonresident beneficiaries when required. If the trustee becomes a
nonresident at any time, I will promptly inform the withholding agent.
Estates — Certification of Residency of Deceased Person:
I am the executor of the above-named person’s estate. The decedent was a California resident at the time of death. The
estate will file a California fiduciary tax return and will withhold on foreign and domestic nonresident beneficiaries when
required.
CERTIFICATE: Please complete and sign below.
Under penalties of perjury, I hereby certify that the information provided herein is, to the best of my knowledge, true and correct. If
conditions change, I will promptly inform the withholding agent.
Vendor/Payee’s name and title (type or print) _____________________________________________________________________
Vendor/Payee’s signature
________________________________________________________ Date _____________________
59003103
Form 590
(REV. 2003)
For Privacy Act Notice, get form FTB 1131 (individuals only).
C2
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