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California Form 592-A Draft - Foreign Partner Or Member Quarterly Withholding Remittance Statement - 2008 Page 3

Voucher at bottom of page.

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Foreign Partner or Member Quarterly

YEAR

CALIFORNIA FORM

Withholding Remittance Statement

2008

592-A

To be filed by the Withholding Agent.

Taxable year: Beginning month __________ day __________ year __________, and ending month __________ day ___________ year __________.

Installment 4

Due by the 15th day of 12th month of taxable year; for weekend or holiday, see instructions.

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Name of Withholding Agent

SSN or ITIN

FEIN

Address (including suite, room, PO Box, or PMB no.)

City

State

ZIP Code

Contact person

Phone

(

)

Amount of payment

Make your check or money order payable to the: “Franchise Tax Board.” Write your SSN or ITIN, or FEIN and “2008 Form 592-A” on it.

Mail this voucher and your check or money order to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0651.

Form 592-A 2007

7091083

For Privacy Notice, get form FTB 1131.

California Form 592-A Draft - Foreign Partner Or Member Quarterly Withholding Remittance Statement - 2008 Page 3