Withholding Agent’s Name: ______________________________________ Withholding Agent’s ID No.: _________________
Schedule of Payees (Enter business or individual name, not both.)
PRINT CLEARLY
Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP code
Total income
Amount of tax withheld
.
.
,
,
,
,
Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP code
Total income
Amount of tax withheld
.
.
,
,
,
,
Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP code
Total income
Amount of tax withheld
.
.
,
,
,
,
SSN or ITIN FEIN CA Corp no. CA SOS file no.
Business name
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP code
Total income
Amount of tax withheld
.
.
,
,
,
,
Side 2 Form 592-F
2015
C3
8082163