California Form 592 - Resident And Nonresident Withholding Statement - 2014
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5Resident and Nonresident
TAXABLE YEAR
CALIFORNIA FORM
2014
592
Withholding Statement
m
m
Amended
Prior Year Distribution
m
m
m
m
April 15, 2014
June 16, 2014
September 15, 2014
January 15, 2015
Due Date:
Part I Withholding Agent
m
m
m
m
FEIN
CA Corp no.
CA SOS file no.
Business name
SSN or ITIN
First name
Initial Last name
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State
ZIP Code
Total Number of Payees
Part II Type of Income
Check all that apply.
m
m
m
A
D
F
Payment to Independent Contractor
Distributions to Domestic Nonresident
Elective Withholding
m
m
B
G
Trust Distributions
Partners/Members/Beneficiaries/
Elective Withholding/Indian Tribe
m
m
C
I
Rents or Royalties
S Corporation Shareholders
Other______________________
m
E
Estate Distributions
Part III Tax Withheld
1 Total tax withheld from Schedule of Payees, excluding backup withholding
.
,
,
(Side 2 and any additional pages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
.
,
,
2 Total backup withholding (Side 2 and any additional pages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
.
,
,
3 Add line 1 and line 2. This is the total amount of tax withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
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,
,
4 Enter amounts of prior payments not previously distributed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
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,
,
5 Enter amount withheld by another entity and being distributed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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,
,
6 Add line 4 and line 5. This is the total amount of payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Total Withholding Amount Due. If line 3 is more than line 6, subtract line 6 from line 3. Remit the
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,
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withholding payment with Form 592-V, along with Form 592. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer has any
knowledge.
Print or type withholding agent's name
Telephone
Sign
(
)
Withholding agent's signature
Date
Here
►
Print or type preparer’s name
Preparer's PTIN
Preparer’s signature
Date
Preparer’s
Use Only
►
Preparer’s address
Telephone
(
)
Form 592
2013 Side 1
7081143
C3
For Privacy Notice, get FTB 1131 ENG/SP.
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