California Form 592-A - Payment Voucher For Foreign Partner Or Member Withholding - 2012
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4Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
2012
Member Withholding
592-A
To be filed by the Withholding Agent.
Taxable year: Beginning month __________ day __________ year __________, and ending month __________ day ___________ year __________.
Installment 1
Due by the 15th day of 4th month of taxable year; for weekend or holiday, see instructions.
FEIN
CA Corp no.
Business name
SSN or ITIN
SOS file no.
First name
Initial Last name
Contact telephone no.
(
)
Address (including suite, room, PO Box, or PMB no.)
City
State
ZIP Code
-
Make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2012 Form 592-A” on the check or
Amount of payment
money order. Mail Form 592-A and check or money order to FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA
94267-0651.
.
00
,
,
Form 592-A 2011
7091123
For Privacy Notice, get form FTB 1131.
DETACH HERE
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
2012
Member Withholding
592-A
To be filed by the Withholding Agent.
Taxable year: Beginning month __________ day __________ year __________, and ending month __________ day ___________ year __________.
Installment 2
Due by the 15th day of 6th month of taxable year; for weekend or holiday, see instructions.
FEIN
CA Corp no.
Business name
SSN or ITIN
SOS file no.
First name
Initial Last name
Contact telephone no.
(
)
Address (including suite, room, PO Box, or PMB no.)
City
State
ZIP Code
-
Make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2012 Form 592-A” on the check or
Amount of payment
money order. Mail Form 592-A and check or money order to FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA
94267-0651.
.
00
,
,
Form 592-A 2011
7091123
For Privacy Notice, get form FTB 1131.
DETACH HERE
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
2012
Member Withholding
592-A
To be filed by the Withholding Agent.
Taxable year: Beginning month __________ day __________ year __________, and ending month __________ day ___________ year __________.
Installment 3
Due by the 15th day of 9th month of taxable year; for weekend or holiday, see instructions.
FEIN
CA Corp no.
Business name
SSN or ITIN
SOS file no.
First name
Initial Last name
Contact telephone no.
(
)
Address (including suite, room, PO Box, or PMB no.)
City
State
ZIP Code
-
Make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2012 Form 592-A” on the check or
Amount of payment
money order. Mail Form 592-A and check or money order to FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA
94267-0651.
.
00
,
,
Form 592-A 2011
7091123
For Privacy Notice, get form FTB 1131.
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