California Form 592-A - Payment Voucher For Foreign Partner Or Member Withholding - 2015 Page 2
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DETACH HERE
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
Member Withholding
2015
592-A
To be filed by the Withholding Agent.
For calendar year 2015 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Installment 4
Due by the 15th day of 12th month of taxable year; for weekend or holiday, see instructions.
FEIN
CA Corp no.
Business name
SSN or ITIN
CA SOS file no.
First name
Initial Last name
Telephone
(
)
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State
ZIP Code
Using black or blue ink, make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2015 Form 592‑A”
Amount of payment
on the check or money order. Mail Form 592‑A and check or money order to FRANCHISE TAX BOARD, PO BOX 942867,
SACRAMENTO CA 94267‑0651.
.
,
,
Form 592‑A 2014
7091153
For Privacy Notice, get FTB 1131 ENG/SP.
DETACH HERE
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
Payment Voucher for Foreign Partner or
TAXABLE YEAR
CALIFORNIA FORM
Member Withholding
2015
592-A
For calendar year 2015 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Supplemental
Use this voucher only if you have a final withholding payment to remit with Form 592-F. The due date of the Supplemental
Payment Voucher is the same as your original due date for Form 592-F, regardless of extension.
Payment Voucher
FEIN
CA Corp no.
CA SOS file no.
Business name
SSN or ITIN
First name
Initial Last name
Telephone
(
)
Address (apt./ste., room, PO Box, or PMB no.)
City (If you have a foreign address, see instructions.)
State
ZIP Code
Using black or blue ink, make check or money order payable to: “Franchise Tax Board.” Write the tax ID no. and “2015 Form 592‑A”
Amount of payment
on the check or money order. Mail Form 592‑A and check or money order to FRANCHISE TAX BOARD, PO BOX 942867,
.
SACRAMENTO CA 94267‑0651.
,
,
Form 592‑A 2014
7091153
For Privacy Notice, get FTB 1131 ENG/SP.
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