Form 592-B - Nonresident Withholding Tax Statement

YEAR

CALIFORNIA FORM

Nonresident Withholding Tax Statement

592-B

FOR RECIPIENT’S

Copy C

RECORDS

Part I

Recipient

Recipient’s name

SSN

Address (number and street)

PMB no.

FEIN

California corp. no.

City

State

ZIP Code

Country

Part II Withholding agent

SSN

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

PMB no.

FEIN

California corp. no.

Address (number and street)

Daytime telephone number

City

State

ZIP Code

(

)

Part III 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 (U.S.)

(describe)

Contractor

Royalties

Nonresident Partner/Member

Part IV Tax Withheld

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

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

contract and/or Form 1099 to determine your

You can view, download, and print California tax

Instructions for Recipient

California source income. If you are a partner,

forms and publications from our Website at

member, or beneficiary of a partnership, LLC,

This withholding of tax does not relieve you of

estate, or trust, see your California Schedule K-1

the requirement to file a California tax return

Assistance for Persons with Disabilities

issued by that entity to determine your California

within three months and fifteen days (two

We comply with the Americans with Disabilities

source income.

months and fifteen days for a corporation) after

Act. Persons with hearing or speech impair-

the close of your taxable year.

ments please call:

Additional Information

You may be assessed a penalty if:

TTY/TDD . . . . . . . . . . . . . . . (800) 822-6268

For additional information or to speak to a

• You do not file a California tax return.

Asistencia Telefonica y en el Internet

representative regarding this form, call the

• You file your tax return late.

Dentro de los Estados Unido

Withholding Services and Compliance Section's

• The amount of withholding does not satisfy

llame al . . . . . . . . . . . . . . . . . (800) 852-5711

automated telephone service at:

your tax liability.

(888) 792-4900 (toll-free) or (916) 845-4900.

Fuera de los Estados Unidos,

How to Claim the Withholding

llame al . . . . . . . . . . . . . . . . . (916) 845-6500

OR Write to:

To claim the withholding credit, enter the

(cargos aplican)

WITHHOLDING SERVICES AND COMPLIANCE

amount on Line 2 on the line for nonresident

Sitio en el Internet:

SECTION

withholding on your California tax return.

FRANCHISE TAX BOARD

Asistencia para Personas Discapacitadas

Attach the top portion of Form 592-B, Copy B

PO BOX 942867

Nosotros estamos en conformidad con el Acta

to the lower front of your California tax return.

SACRAMENTO CA 94267-0651

de Americanos Discapacitados. Personas con

Note: If you are a partnership, limited liability

problemas auditivos pueden llamar al TTY/TDD

For information on requirements to file a

company (LLC), estate, or trust and the amount

(800) 822-6268.

California tax return or to get forms, call:

on Line 2 exceeds your tax liability, you must file

Form 592, Nonresident Withholding Annual

From within the

Return, and allocate the excess credit to the

United States . . . . . . . . . . . . . (800) 852-5711

partners, members, or beneficiaries.

From outside the

S corporations may also flow the withholding

United States . . . . . . . . . . . . . (916) 845-6500

credit through to shareholders using Form 592.

(not toll-free)

OR Write to:

Caution: The amount shown as “Total amount

subject to withholding” may be an estimate or

TAX FORMS REQUEST SECTION

may only reflect how withholding was calculated.

FRANCHISE TAX BOARD

Be sure to report your actual taxable California

PO BOX 307

source income. If you are an independent

RANCHO CORDOVA CA 95741-0307

contractor or receive rents or royalties, see your

592B04104

Form 592-B 2004

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

Form 592-B - Nonresident Withholding Tax Statement - 2004 Page 3

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