TAXABLE YEAR
CALIFORNIA FORM
2012
587
Nonresident Withholding Allocation Worksheet
Part I
Withholding Agent
Withholding agent’s name
Address (number and street, PO Box, or PMB no.)
Apt. no./Ste. no.
City
State
ZIP Code
Part II
Nonresident Payee (Complete Part II through Part V and return this form to the above withholding agent)
Payee’s name
Owner’s full name if sole proprietor
Address (number and street, PO Box, or PMB no.)
Apt. no./Ste. no.
City
State
ZIP Code
Daytime telephone number
Secretary of State (SOS) file no.
SSN or ITIN
CA Corp. no.
FEIN
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)
Nonresident payee’s entity type: (Check one)
Individual/sole proprietor
Corporation
Partnership
Limited liability company (LLC)
Estate or trust
Part III Payment Type
Nonresident payee: (Check one)
Performs services totally outside California (no withholding required, skip to Part V)
Provides only goods or materials (no withholding required, skip to Part V)
Provides goods and services in California (see allocation in Part IV)
Provides services within and outside California (see allocation in Part IV)
Other (Describe)____________________________________________________________
If the payee performs all the services within California, withholding is required on the entire payment for services unless the payee is granted a withholding
waiver from the Franchise Tax Board (FTB) . For more information, get FTB Pub . 1017, Resident and Nonresident Withholding Guidelines .
Part IV Income Allocation
Gross payments expected from the above withholding agent during the calendar year for:
(a) Within California
(b) Outside California
(c) Total payments
1 Goods and services:
Goods/materials (no withholding required) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___________________________
Services (withholding required) . . . . . . . . . . . . ___________________________ ___________________________ ___________________________
2 Rents or lease payments . . . . . . . . . . . . . . . . . . . ___________________________ ___________________________ ___________________________
3 Royalty payments . . . . . . . . . . . . . . . . . . . . . . . . ___________________________ ___________________________ ___________________________
4 Prizes and other winnings . . . . . . . . . . . . . . . ___________________________ ___________________________ ___________________________
5 Other payments . . . . . . . . . . . . . . . . . . . . . . . . . . ___________________________ ___________________________ ___________________________
6 Total payments subject to withholding .
Add column (a), line 1 through line 5 . . . . . . . ___________________________ ___________________________ ___________________________
Withholding threshold amount: . . . . . . . . . . . . .
$1,500 .00
Withholding is optional, at the discretion of the withholding agent, on the first $1,500 in payments made during the calendar year . Withholding must begin as
soon as the total payments of California source income for the calendar year exceed $1,500 . If the FTB grants the withholding waiver, attach a copy of the FTB
determination letter . See General Information E, Waivers .
Part V
Certification of Payee
Under penalties of perjury, I certify that the information provided on this document is true and correct. If the reported facts change, I will promptly inform the withholding agent.
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)
Authorized representative’s signature
Title
Daytime telephone number
(
)
Payee’s signature
Date
Daytime telephone number
Form 587
2011
7041123
C2
For Privacy Notice, get form FTB 1131.