California Form 590 - Withholding Exemption Certificate - 2012
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1
2
3Withholding Exemption Certificate
CALIFORNIA FORM
YEAR
590
2012
(This form can only be used to certify exemption from nonresident withholding under California Revenue
and Taxation Code (R&TC) Section 18662. Do not use this form for exemption from wage withholding.)
File this form with your withholding agent. (Please type or print)
Withholding agent’s name
Payee’s name
Payee’s
SSN or ITIN
SOS file no.
CA corp. no.
FEIN
Address (number and street, PO Box, or PMB no.)
Apt. no./ Ste. no.
City
State
ZIP Code
Read the following carefully and check the box that applies to the payee.
I certify that for the reasons checked below, the payee named on this form is exempt from the California income tax withholding
requirement on payment(s) made to the entity or individual.
Individuals — Certification of Residency:
I am a resident of California and I reside at the address shown above. If I become a nonresident at any time, I will promptly
notify the withholding agent. See instructions for General Information D, Who is a Resident, for the definition of a resident.
Corporations:
The above-named corporation has a permanent place of business in California at the address shown above or is qualified
through the California Secretary of State (SOS) to do business in California. The corporation will file a California tax return
and withhold on payments of California source income to nonresidents when required. If this corporation ceases to have
a permanent place of business in California or ceases to do any of the above, I will promptly notify the withholding agent.
See instructions for General Information F, What is a Permanent Place of Business, for the definition of permanent place of
business.
Partnerships or limited liability companies (LLC):
The above-named partnership or LLC has a permanent place of business in California at the address shown above or is
registered with the California SOS, and is subject to the laws of California. The partnership or LLC will file a California tax
return and will withhold on foreign and domestic nonresident partners or members when required. If the partnership or
LLC ceases to do any of the above, I will promptly inform the withholding agent. For withholding purposes, a limited liability
partnership (LLP) is treated like any other partnership.
Tax-Exempt Entities:
The above-named entity is exempt from tax under California Revenue and Taxation Code (R&TC) Section 23701 ______
(insert letter) or Internal Revenue Code Section 501(c) _____ (insert number). The tax-exempt entity will withhold on payments
of California source income to nonresidents when required. If this entity ceases to be exempt from tax, I will promptly notify the
withholding agent. Individuals cannot be tax-exempt entities.
Insurance Companies, Individual Retirement Arrangements (IRAs), or Qualified Pension/Profit Sharing Plans:
The above-named entity is an insurance company, IRA, or a federally qualified pension or profit-sharing plan.
California Trusts:
At least one trustee and one noncontingent beneficiary of the above-named trust is a California resident. The trust will file a
California fiduciary tax return and will withhold on foreign and domestic nonresident beneficiaries when required. If the trustee
becomes a nonresident at any time, I will promptly notify the withholding agent.
Estates — Certification of Residency of Deceased Person:
I am the executor of the above-named person’s estate. The decedent was a California resident at the time of death. The estate
will file a California fiduciary tax return and will withhold on foreign and domestic nonresident beneficiaries when required.
Nonmilitary Spouse of a Military Servicemember:
I am a nonmilitary spouse of a military servicemember and I meet the Military Spouse Residency Relief Act (MSRRA)
requirements. See instructions for General Information E, MSRRA.
CERTIFICATE: Please complete and sign below.
Under penalties of perjury, I hereby certify that the information provided in this document is, to the best of my knowledge, true and
correct. If conditions change, I will promptly notify the withholding agent.
Payee’s name and title (type or print) _________________________________ Daytime telephone no.________________________
Payee’s signature _______________________________________________________________ Date ____________________
Form 590
2011
7061123
C2
For Privacy Notice, get form FTB 1131.
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