California Form 592-F - Foreign Partner Or Member Annual Return - 2012 Page 2
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2Withholding Agent’s (Payer’s) Name: _______________________ Withholding Agent’s (Payer’s) ID No.: _________________
Schedule of Payees
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Business name
SSN or ITIN FEIN CA Corp no. SOS file no.
First name
Initial Last name
If backup withholding, check
the box (see instructions)
Address (suite, room, PO Box, or PMB no.)
City (if you have a foreign address, see instructions)
State ZIP Code
Total income
Amount of tax withheld
.
.
00
,
,
,
,
00
Business name
SSN or ITIN FEIN CA Corp no. SOS file no.
First name
Initial Last name
If backup withholding, check
the box (see instructions)
Address (suite, room, PO Box, or PMB no.)
City (if you have a foreign address, see instructions)
State ZIP Code
Total income
Amount of tax withheld
.
.
00
,
,
,
,
00
Business name
SSN or ITIN FEIN CA Corp no. SOS file no.
First name
Initial Last name
If backup withholding, check
the box (see instructions)
Address (suite, room, PO Box, or PMB no.)
City (if you have a foreign address, see instructions)
State ZIP Code
Total income
Amount of tax withheld
.
.
00
,
,
,
,
00
Business name
SSN or ITIN FEIN CA Corp no. SOS file no.
First name
Initial Last name
If backup withholding, check
the box (see instructions)
Address (suite, room, PO Box, or PMB no.)
City (if you have a foreign address, see instructions)
State ZIP Code
Total income
Amount of tax withheld
.
.
00
,
,
,
,
00
Total Income and Withholding for This Page Only
Notice: We require the total amounts below to be calculated and submitted separately for each page.
Total Income
Total California Tax Withheld Excluding
Total Backup Withholding
Backup Withholding
.
00
.
,
,
.
00
00
,
,
,
,
Side 2 Form 592-F
2011
C3
8082123
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