Form 592 - Resident And Nonresident Withholding Statement - 2010
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1
2TAXABLE YEAR
CALIFORNIA FORM
Resident and Nonresident Withholding Statement
2010
592
m
m
Amended
Prior Year Distribution
m
m
m
m
April 15, 2010
June 15, 2010
September 15, 2010
January 18, 2011
Payment Due Date:
Part I Withholding Agent
m
m
m
Business name
SSN or ITIN
FEIN
CA Corp no.
First name
Initial Last name
Address (number and street, suite, Apt., PO Box, or PMB no.)
City
State
ZIP Code
Total Number of Payees Included
Part II Type of Income
Check all that apply.
m
m
m
A
D
F
Payment to Independent Contractor
Distributions to Domestic Nonresident
Elective Withholding
m
m
B
G
Trust Distributions
Partners/Members/Beneficiaries/
Elective Withholding/Indian Tribe
m
m
C
H
Rents or Royalties
S Corporation Shareholders
Other______________________
m
E
Estate Distributions
.
00
,
,
1 Total Withholding, excluding Backup Withholding (Side 2 and any additional pages) . . . . . . . . . . . . . . . . . . . .
1
.
00
,
,
2 Total Backup Withholding (Side 2 and any additional pages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
.
00
,
,
3 Add line 1 and line 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
.
00
,
,
4 Enter amounts of prior payments not previously distributed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
.
00
,
,
5 Enter amount withheld by another entity and being distributed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.
,
00
6 Add line 4 and line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
,
7 Total Withholding Amount Due. Subtract line 6 from line 3. Remit the withholding payment with
.
00
,
,
Form 592-V, Payment Voucher for Resident and Nonresident Withholding, along with Form 592.. . . . . . . . . .
7
Part III Perjury Statement
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer has any knowledge.
(
)
Withholding agent’s name ______________________________________________
Withholding agent’s daytime phone number ______________________
Withholding agent’s signature ______________________________________________________________________________________________________
Preparer’s name ______________________________________________________
Preparer’s signature ________________________________________
Preparer’s address _______________________________________________________________________________________________________________
(
)
Preparer’s SSN/PTIN __________________________________________________
Preparer’s phone daytime phone number_________________________
Form 592
2009 Side 1
7081103
For Privacy Notice, get form FTB 1131.
C3
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