California Form 592-F - Foreign Partner Or Member Annual Return - 2015 Page 2
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4Withholding Agent’s Name: ______________________________________ Withholding Agent’s ID No.: _________________
Schedule of Payees (Enter business or individual name, not both.)
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Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP Code
Total income
Amount of tax withheld
.
.
,
,
,
,
Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP Code
Total income
Amount of tax withheld
.
.
,
,
,
,
Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP Code
Total income
Amount of tax withheld
.
.
,
,
,
,
Business name
SSN or ITIN FEIN CA Corp no. CA SOS file no.
First name
Initial Last name
If backup withholding, check
the box
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State ZIP Code
Total income
Amount of tax withheld
.
.
,
,
,
,
Side 2 Form 592-F
2014
C3
8082153
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