California Form 593-W - Real Estate Withholding Exemption Certificate And Waiver Request For Non-Individual Sellers - 2004

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YEAR

Real Estate Withholding Exemption Certificate and

CALIFORNIA FORM

2004

Waiver Request for Non-Individual Sellers

593-W

Withholding Exemption Certificate

Part I

– Seller’s Information

Name

CA Corp. No.

FEIN

SOS File No.

Social Security No.

Address

Private Mailbox No.

Note: If you do not furnish your tax ID

number this certificate is void.

City, State, ZIP Code

Daytime Number

Ownership Percentage

(

)

_______

____

Property address (if no street address, provide parcel number and county)

Read the following and check the appropriate box. (See line-by-line instructions, Part II – Withholding Exemption Certificate.)

Part II

– Certifications that fully exempt the sale from withholding:

YES NO

1. Is the seller a corporation that is either qualified through the California Secretary of State or has a permanent place of business in California? .

2. Is the seller a partnership with recorded title to the property in the name of the partnership? (If yes, the partnership must withhold on

nonresident partners as required. Get FTB Pub. 1017, Nonresident Withholding Partnership Guidelines , for information.) . . . . . . . . . . . . . . . .

3. Is the seller (recorded title holder) a limited liability company (LLC) that is classified as a partnership and is not a disregarded single member

LLC for federal and California income tax purposes? (If yes, the LLC must withhold on nonresident members as required.

Get FTB Pub. 1017, Nonresident Withholding Partnership Guidelines , for information.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Is the seller a tax-exempt entity under either California or federal law? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Is the seller an irrevocable trust with at least one trustee who is a California resident? (If yes, the trust must file a California tax return to

report the sale and withhold when distributing California source taxable income to nonresident beneficiaries as required. Get FTB Pub. 1023,

Nonresident Withholding Independent Contractor, Rent & Royalty Guidelines , for information.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Is the seller an estate where the decedent was a California resident at the time of death? (If yes, the estate must file a California fiduciary tax

return to report the sale and withhold when distributing California source taxable income to nonresident beneficiaries as required.

Get FTB Pub. 1023, Nonresident Withholding Independent Contractor, Rent & Royalty Guidelines , for information.) . . . . . . . . . . . . . . . . . . . . .

7. Is the seller an insurance company, Individual Retirement Account (IRA), qualified pension/profit sharing plan, or

Charitable Remainder Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Seller’s Signature

Under penalties of perjury, I hereby certify that the information provided above is, to the best of my knowledge, true and correct. If conditions change, I

will promptly inform the withholding agent

I understand that completing this form does not exempt me from filing a California income or franchise tax

return to report this sale.

Seller’s name and title (type or print)______________________________________________________________________________________

Seller’s signature______________________________________________________________________ Date:___________________________

Seller:

If you checked “YES” to any of the above questions, STOP HERE. You are exempt from real estate withholding. Provide this form to your escrow

company or the buyer (withholding agent).

If you checked “NO” to all of the above questions, you are subject to the real estate withholding requirements. The required withholding is 3

percent of the total sales price. Do you expect your tax liability from the sale of this property to be substantially less than that amount? If so, would

you like to request a reduced amount of withholding?

Yes. Complete the Withholding Waiver Request (Part III) and send it to the Franchise Tax Board before the close of escrow.

No.

STOP HERE. The withholding agent will withhold 3

percent of the total sales price and send it to us on your behalf. The withholding

agent should give you two copies of Form 593-B, Real Estate Withholding Tax Statement . Attach one copy to the lower front of your

California income tax return and keep the other copy for your records.

Withholding Agent:

If you are required to withhold, complete Form 593-B, Real Estate Withholding Tax Statement , give two copies to the seller, and send

one copy to the Franchise Tax Board with the withholding payment and Form 593, Real Estate Withholding Remittance Statement .

Refer to Form 593 and Form 593-B instructions for more information.

593W03103