Form 592 "Resident and Nonresident Withholding Statement" - California

Form 592 or the "Resident And Nonresident Withholding Statement" is a form issued by the California Franchise Tax Board.

The form was last revised in January 1, 2017 and is available for digital filing. Download an up-to-date Form 592 in PDF-format down below or look it up on the California Franchise Tax Board Forms website.

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Resident and Nonresident
TAXABLE YEAR
CALIFORNIA FORM
2018
592
Withholding Statement
I m
I m
Amended
Prior Year Distribution
:
I
m
m
m
m
Due Date:
April 15, 2018
June 15, 2018
September 15, 2018
January 15, 2019
Part I Withholding Agent Information
m
m
m
m
Business name
SSN or ITIN
  FEIN
  CA Corp no.
  CA SOS file no.
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
I
Check all that apply.
m
m
m
A
D
F
Payments to Independent Contractors
Distributions to Domestic Nonresident
Elective Withholding
Partners/Members/Beneficiaries/
m
m
B
G
Trust Distributions
 Elective Withholding by Indian Tribe
S Corporation Shareholders
m
m
m
C
E
I
Rents or Royalties
Other______________________
 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
.
,
,
4 Amount of prior payments not previously distributed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
.
,
,
5 Amount withheld by another entity and being distributed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.
,
,
6 Add line 4 and line 5. This is the total amount of payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Total Withholding Amount Due. Subtract line 6 from line 3. Remit the withholding payment with
.
,
,
Form 592-V, along with Form 592. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information,
go to ftb.ca.gov/forms and search for 1131. To request this notice by mail, call 800.852.5711.
Under penalties of perjury, I declare that I have examined this form, 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 2017 Side 1
7081183
Resident and Nonresident
TAXABLE YEAR
CALIFORNIA FORM
2018
592
Withholding Statement
I m
I m
Amended
Prior Year Distribution
:
I
m
m
m
m
Due Date:
April 15, 2018
June 15, 2018
September 15, 2018
January 15, 2019
Part I Withholding Agent Information
m
m
m
m
Business name
SSN or ITIN
  FEIN
  CA Corp no.
  CA SOS file no.
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
I
Check all that apply.
m
m
m
A
D
F
Payments to Independent Contractors
Distributions to Domestic Nonresident
Elective Withholding
Partners/Members/Beneficiaries/
m
m
B
G
Trust Distributions
 Elective Withholding by Indian Tribe
S Corporation Shareholders
m
m
m
C
E
I
Rents or Royalties
Other______________________
 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
.
,
,
4 Amount of prior payments not previously distributed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
.
,
,
5 Amount withheld by another entity and being distributed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
.
,
,
6 Add line 4 and line 5. This is the total amount of payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Total Withholding Amount Due. Subtract line 6 from line 3. Remit the withholding payment with
.
,
,
Form 592-V, along with Form 592. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information,
go to ftb.ca.gov/forms and search for 1131. To request this notice by mail, call 800.852.5711.
Under penalties of perjury, I declare that I have examined this form, 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 2017 Side 1
7081183
Withholding Agent Name: ______________________________________ Withholding Agent TIN:__________________
Schedule of Payees (Enter business or individual name, not both.)
PRINT CLEARLY
Business name
m FEIN m CA Corp no. m CA SOS file no.
First name
Last name
SSN or ITIN
Initial
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
m
 If backup withholding, check the box.
.
.
,
,
,
,
Business name
m FEIN m CA Corp no. m CA SOS file no.
First name
Last name
SSN or ITIN
Initial
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
m
 If backup withholding, check the box.
.
.
,
,
,
,
Business name
m FEIN m CA Corp no. m CA SOS file no.
First name
Last name
SSN or ITIN
Initial
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
m
 If backup withholding, check the box.
.
.
,
,
,
,
Business name
m FEIN m CA Corp no. m CA SOS file no.
First name
Initial
Last name
SSN or ITIN
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
m
 If backup withholding, check the box.
.
.
,
,
,
,
Side 2 Form 592 2017
7082183
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