Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
2017
Member Withholding
592-A
The withholding agent completes and files this form.
For calendar year 2017 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Installment 1
Due by the 15th day of 4th month of taxable year; for weekend or holiday, see instructions.
Business name
FEIN
CA Corp no.
CA SOS file no.
First name
Initial Last name
Telephone
(
)
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State
ZIP code
-
Using black or blue ink, make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2017 Form 592‑A”
Amount of payment
on the check or money order. Mail Form 592‑A and check or money order to WITHHOLDING SERVICES AND COMPLIANCE,
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267‑0651.
.
,
,
7091173
Form 592‑A 2016
DETACH HERE
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
2017
Member Withholding
592-A
The withholding agent completes and files this form.
For calendar year 2017 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Installment 2
Due by the 15th day of 6th month of taxable year; for weekend or holiday, see instructions.
Business name
FEIN
CA Corp no.
CA SOS file no.
First name
Initial Last name
Telephone
(
)
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State
ZIP code
-
Amount of payment
Using black or blue ink, make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2017 Form 592‑A”
on the check or money order. Mail Form 592‑A and check or money order to WITHHOLDING SERVICES AND COMPLIANCE,
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267‑0651.
.
,
,
7091173
Form 592‑A 2016
DETACH HERE
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
Member Withholding
2017
592-A
The withholding agent completes and files this form.
For calendar year 2017 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Installment 3
Due by the 15th day of 9th month of taxable year; for weekend or holiday, see instructions.
Business name
FEIN
CA Corp no.
CA SOS file no.
First name
Initial Last name
Telephone
(
)
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State
ZIP code
-
Using black or blue ink, make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2017 Form 592‑A”
Amount of payment
on the check or money order. Mail Form 592‑A and check or money order to WITHHOLDING SERVICES AND COMPLIANCE,
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267‑0651.
.
,
,
7091173
Form 592‑A 2016