TAXABLE YEAR
CALIFORNIA FORM
2012
Nonresident Reduced Withholding Request
589
Part I Withholding Agent
m SSN or ITIN m FEIN m CA Corp no. m SOS file no.
Business name
First name
Initial Last name
Address (suite, room, PO Box, or PMB no.)
Withholding Agent fax number
–
( )
City
State
ZIP Code
Daytime telephone number
–
–
( )
Venue
Part II Payee
m SSN or ITIN m FEIN m CA Corp no. m SOS file no.
Business name
First name
Initial Last name
DBA (if applicable)
Address (suite, room, PO Box, or PMB no.)
City
State
ZIP Code
Payee fax number
–
–
( )
Part III Type of Income Subject to Withholding
I
Check one type only.
m
m
m
A
Payment to Independent Contractor
C
Rents or Royalties
E
Estate Distributions
m
m
m
B
Trust Distributions
D
Distributions to Domestic Nonresident
F
Other _____________________
S Corporation Shareholders/Partners/
I
Date(s) of Service __________________________
Members/Beneficiaries
MM/DD/YYYY - MM/DD/YYYY
Part IV Withholding Amount
I
.
00
,
,
1 Gross California Source Payment. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
I
.
,
,
00
2 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
I
.
,
,
00
3 Commissions and fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
I
.
00
,
,
4 Cost of labor (contract labor) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
I
.
,
00
,
5 Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
I
.
,
,
00
6 Legal, professional, and/or management fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
I
.
00
,
,
7 Rent or lease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
I
.
00
,
,
8 Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
I
.
,
,
00
9 Travel, meals, and entertainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
Other Expenses (specify). See instructions.
I
.
10 ________________________________________________ . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
,
,
00
I
.
11 ________________________________________________ . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
,
,
00
I
.
00
,
,
12 Total amount of expenses. Add line 2 through 11.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
I
.
13 Net California Source Payment. Subtract line 12 from line 1. If zero or less, enter 0.. . . . . . . . .
13
,
,
00
14 Withholding Amount. Multiply the amount on line 13 by seven percent (.07). This is the
proposed reduced withholding amount. This amount must be verified and approved by the
I
.
,
,
00
Franchise Tax Board (FTB) prior to the requestor receiving payment for services. . . . . . . . . . . . . . .
14
Part V Payee’s Signature
Under penalties of perjury, I hereby certify that the information provided is, to the best of my knowledge, true and correct. I understand that the Franchise Tax Board
may review all relevant documentation upon request in order to verify the payment amount and expenses above.
_________
Payee’s Name ______________________________________________________________________ Phone Number:
____________
( )
Payee’s Signature_____________________________________________________________________________________ Date:_____________
Preparer’s Name_____________________________________________________________________ Phone Number:______________________
( )
Preparer’s Signature_______________________________________________________________ Date: ____________ PTIN________________
Form 589
2011
C2
8101123
For Privacy Notice, get form FTB 1131.