Form 592-B - Nonresident Withholding Tax Statement (Page 4 of 5) in pdf

YEAR

CALIFORNIA FORM

Nonresident Withholding Tax Statement

592-B

FOR WITHHOLDING

Copy D

AGENT

Recipient

Part I

Recipient’s name

SSN

Address (number and street)

PMB no.

FEIN

California corp. no.

City

Province or state

Postal code, and country

Part II Withholding agent (Payer/Partnership/Limited Liability Company)

SSN

Withholding agent’s (payer’s/partnership’s/limited liability company’s) name

FEIN

California corp. no.

Address (number and street)

PMB no.

Daytime telephone number

City

State

ZIP Code

(

)

Part III Preparer (if other than withholding agent)

Preparer’s name

SSN/PTIN

FEIN

California corp. no.

Address (number and street)

PMB no.

City

State

ZIP Code

Daytime telephone number

(

)

Part IV Type of income subject to withholding. Check the applicable box(es).

Payment to

Rents

Estate

Trust

Allocations

Distributions

Other___________________________

Independent

Distributions

to Foreign (non-U.S.)

to Domestic (nonforeign)

(describe)

Contractor

Royalties

Nonresident Partner/Member

Part V Tax Withheld

1 Total amount subject to withholding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Total California tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IMPORTANT INFORMATION – PLEASE READ

Corporation Franchise or Income Tax Return; Form 100W, California

Corporation Franchise or Income Tax Return — Water’s-Edge Filers;

Form 100S, California S Corporation Franchise or Income Tax Return;

RECIPIENT:

or Form 541, California Fiduciary Income Tax Return.

If you are an individual or corporation, enter the amount from Part V,

line 2 on the nonresident withholding line of your California tax return.

Even if you do not have a California filing requirement, you should file

Attach the top portion of Form 592-B, Copy B, to the front of your tax

if California tax has been withheld. For more information, call

return.

(800) 852-5711 from within the United States, or (916) 845-6500 (not

toll-free) from outside the United States.

If you are a partnership, LLC, S corporation, Estate, or Trust, and the

amount on line 2 exceeds your tax liability, you must file Form 592,

You may be assessed a penalty if:

Nonresident Withholding Annual Return, and allocate the excess credit

• You fail to file a tax return.

to the partners, members, or beneficiaries.

• You file your tax return late.

Keep Copy C for your records.

• The amount of withholding does not satisfy your tax liability.

The withholding of tax does not relieve you of the requirement to file a

WITHHOLDING AGENT:

California tax return within three months and fifteen days (for individuals

You must file Copy A of this form together with Form 592, Nonresident

and fiduciaries) or two months and fifteen days (for corporations) after

Withholding Annual Return, with the Franchise Tax Board. See the

the close of your taxable year. If you cannot file the tax return by the

instructions for Forms 592, 592-A, and 592-B for when and where to

due date, an automatic extension to file is granted (six months for

file returns of tax withheld at source.

individuals, fiduciaries, partnerships, LLCs, and seven months for

corporations). However, you must pay your tax liability by the original

Direct correspondence to:

due date.

WITHHOLDING SERVICES AND COMPLIANCE SECTION

To determine if you must file a tax return, refer to the instructions for

FRANCHISE TAX BOARD

your tax return: Form 540, California Resident Income Tax Return;

PO BOX 651

Long Form 540NR, California Nonresident or Part-Year Resident

SACRAMENTO CA 95812-0651

Income Tax Return; Form 565, Partnership Return of Income; Form 568,

or telephone: (888) 792-4900, (916) 845-4900 (not toll-free).

Limited Liability Company Return of Income; Form 100, California

592B03104

Form 592-B

(REV. 2003)

For Privacy Act Notice, get form FTB 1131 (Individuals only).

Form 592-B - Nonresident Withholding Tax Statement Page 4

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