California Form 592 - Resident And Nonresident Withholding Statement - 2015 Page 2
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5Withholding Agent Name: ___________________________________ Withholding Agent ID No.:__________________
Schedule of Payees (Enter business or individual name, not both.)
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Business name
m SSN or ITIN m FEIN m CA Corp no. m CA SOS file no.
First name
Last name
Initial
m
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
m SSN or ITIN m FEIN m CA Corp no. m CA SOS file no.
First name
Last name
Initial
m
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
m SSN or ITIN m FEIN m CA Corp no. m CA SOS file no.
First name
Last name
Initial
m
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
m SSN or ITIN m FEIN m CA Corp no. m CA SOS file no.
First name
Initial
Last name
m
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
2014
C3
7082153
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