California Form 592-A - Payment Voucher For Foreign Partner Or Member Withholding - 2017 Page 2
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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 4
Due by the 15th day of 12th 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
Member Withholding
2017
592-A
For calendar year 2017 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Supplemental
Use this voucher only if you have a final withholding payment to remit with Form 592-F. The due date of the Supplemental
Payment Voucher
Payment Voucher is the same as your original due date for Form 592-F, regardless of extension.
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
,
,
Form 592‑A 2016
7091173
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