Form Csusm 204 PDF Details

The CSUSM 204 form, integral to financial transactions within the State of California, serves as a necessary adjustment to the IRS W-9 for businesses engaging with the state's entities, emphasizing the significance of accurate data provision for tax-related purposes. Tailored by the California State University San Marcos, this form is crucial for preparing informational returns such as Form 1099 and ensuring proper withholding on payments to nonresident payees. Its comprehensive design requests detailed information including the payee’s business name, tax identification numbers, and residency status, aiming to streamline the payment process while adhering to tax compliance and enforcement activities stipulated by Federal and State laws. Additionally, it underscores the diverse classifications of payees, from individuals and sole proprietors to various types of corporations, elucidating the obligations and tax withholding implications pertinent to each. The document further educates on the distinctions in residency and the subsequent tax implications, thereby facilitating a better understanding among payees regarding their fiscal duties and potential withholdings. Also embedded within this form is a nod towards the privacy concerns and legal rights of the payee, detailing the legislative backing for information collection and the critical avenues for addressing queries or concerns, painting a holistic view of the meticulous efforts by the state to ensure transparency, legal compliance, and ease of processing payments.

QuestionAnswer
Form NameForm Csusm 204
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesPayeeDataRecord 031309 cal state university san marcos w 9 form

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STATE OF CALIFORNIA

PAYEE DATA RECORD

(Required in lieu of IRS W-9 when doing business with the State of California)

CSUSM 204 (Rev. 03-2009)

NOTE: Governmental entities, federal, state, and local (including public school districts) are not required to submit this form.

 

CALIFORNIA STATE UNIVERSITY SAN MARCOS

PURPOSE: Information contained in this form

 

 

 

 

 

 

 

 

 

 

 

 

ATTN: ACCOUNTS PAYABLE

 

 

 

 

1

 

 

 

 

will be used by state agencies to prepare

 

 

 

 

 

 

 

 

 

 

information Returns (Form 1099) and for

333 S. TWIN OAKS VALLEY ROAD

 

 

 

 

PLEASE

 

 

 

 

withholding

on payments to

nonresident payees.

 

 

 

 

 

 

 

 

 

 

Prompt return of

this fully

completed form will

RETURN

 

 

 

 

 

 

 

 

 

 

SAN MARCOS, CA 92096-0001

 

 

 

 

 

 

 

 

prevent delays when processing payments.

TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(760) 750-4555 or Fax to (760) 750-3286

 

 

 

 

(See Privacy Statement on reverse)

 

PAYEE’S BUSINESS NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOLE PROPRIETOR – ENTER OWNER’S FULL NAME HERE (Last, First, M.I.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AND

MAILING ADDRESS (Number and Street or P.O. Box Number)

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(City, State, and Zip Code)

 

 

 

 

PAYEE URL WEBSITE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYEE PHONE NUMBER

 

 

PAYEE FAX NUMBER

 

 

 

PAYEE EMAIL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INDIVIDUAL/SOLE

 

 

PARTNERSHIP

 

ESTATE OR TRUST

 

 

VENDOR TYPE:

 

PROPRIETOR (Must provide

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Social Security #) See below

 

 

 

 

 

 

 

 

 

 

 

 

 

SMALL BUSINESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LIMITED

 

 

EXEMPT

 

 

 

 

 

 

 

 

 

 

 

VENDOR

LIABILITY COMPANY

 

 

ORGANIZATION

 

 

 

 

 

 

 

 

 

MICRO BUSINESS

ENTITY &

 

 

 

 

(Nonprofit)

 

 

 

 

 

 

 

 

 

 

 

PAYMENT

MEDICAL CORPORATION

LEGAL (e.g.,

 

ALL OTHER CORPORATIONS

 

DISABLED

TYPE

 

 

VETERAN OWNED

(e.g., dentistry, podiatry, chiropractic,

attorney services)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

optometry, etc.)

 

 

CORPORATION

 

 

 

 

 

 

 

 

 

OSBCR CERTIFICATE

 

GOODS

 

 

GOODS/SERVICES

 

SERVICES ONLY

 

 

 

 

 

 

 

 

NO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RENT

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER REQUIRED FOR INDIVIDUAL/SOLE PROPRIETOR BY AUTHORITY OF THE

 

NOTE: Payment will

 

REVENUE AND TAXATION CODE SECTION 18646 (SEE REVERSE)

 

 

 

 

 

 

 

 

 

not be processed

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

without accompanying

FEDERAL EMPLOYERS IDENTIFICATION NUMBER (FEIN)

 

SOCIAL SECURITY NUMBER/ITIN

 

 

taxpayer I.D. number.

PAYEE’S

 

-

 

 

 

 

 

- -

 

 

 

 

 

 

TAXPAYER

IF PAYEE ENTITY TYPE IS A CORPORATION, PARTNERSHIP,

 

IF PAYEE ENTITY TYPE IS INDIVIDUAL OR

 

 

 

I.D. NUMBER

ESTATE OR TRUST, ENTER FEIN.

 

 

SOLEPROPRIETOR, ENTER SSN.

 

 

 

 

 

 

 

 

 

 

 

ITIN / SSN IF RESIDENT OF FOREIGN

 

 

 

 

 

 

 

 

 

 

 

COUNTRY.

 

 

 

 

5

Check All Boxes that Apply

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE:

 

Federal Income Tax Withholding Status (Applies to Individuals Only):

 

 

Prior to making payments to

 

 

foreign citizens, United States

PAYEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am a U.S. Citizen

I am a Permanent Resident Alien and I have a Green Card

 

 

tax laws require all employers to

RESIDENCY

I am not a U.S. Citizen and I do not have a Permanent Resident Green Card

 

 

perform a tax analysis with

DECLARATION

 

 

respect to country of citizenship

Note: All Foreign Citizens/Entities must complete a tax analysis before payments can be made.

 

 

FOR TAX

 

 

to determine residency for

Tax Exempt by Tax Treat. Country of Residency:

 

 

 

 

 

 

 

 

 

PURPOSES

 

 

 

 

 

 

 

 

 

Federal tax purposes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please see Reverse)

 

TIN RCS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All payments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

made by the

California State Tax Withholding Status (Applies to all Payees):

 

 

 

 

 

 

 

 

 

NOTE:

 

University are

California Resident Qualified to do business in CA or have a permanent place of business in CA.

 

 

An estate is a resident if

subject to Federal

 

 

decedent was a California

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

California Nonresident (See Reverse). Payments to CA nonresidents may be subject to state taxes.

 

 

resident at time of death. A trust

and California

 

 

A Waiver from CA state tax withholding is attached (From the California Franchise Tax Board).

 

is resident if one or more trustees

State tax laws

 

 

are CA residents. Rules for

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All services related to this payment were performed OUTSIDE of the state of California.

 

 

 

 

 

assessing State taxes differ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

significantly from Federal tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rules. (Please see Reverse)

6

I hereby certify under penalty of perjury under the laws of the State of California that the information provided on this

document is true and correct. If my residency status should change, I will promptly inform you.

 

CERTIFYING

 

AUTHORIZED PAYEE REPRESENTATIVE’S NAME (Print)

 

TITLE

 

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE

 

 

 

 

 

DATE

 

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REV03/09

PAYEE DATA RECORD

CSUSM. 204 (REV03/09) (REVERSE)

ARE YOU A RESIDENT OR A NONRESIDENT?

Each corporation, individual/sole proprietor, partnership, estate or trust doing business with the State of California must indicate their residency status along with their taxpayer identification number.

A corporation will be considered a "resident" if it has a permanent place of business in California. The corporation has a permanent place of business in California if it is organized and existing under the laws of this state or, if a foreign corporation has qualified to transact intrastate business. A corporation that has not qualified to transact intrastate business (e.g., a corporation engaged exclusively in interstate commerce) will be considered as having a permanent place of business in this state only if it maintains a permanent office in this state that is permanently staffed by its employees.

For individuals/sole proprietors, the term "resident" includes every individual who is in California for other than a temporary or transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes to California for a purpose which will extend over a long or indefinite period will be considered a resident. However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.

For withholding purposes, a partnership is considered a resident partnership if it has a permanent place of business in California. An estate is considered a California estate if the decedent was a California resident at the time of death and a trust is considered a California trust if at least one trustee is a California resident.

More information on residency status can be obtained by calling the Franchise Tax Board at the numbers listed below:

From within the United States, cal1 …1-800-852-5711 From outside the United States, call …1-916-845-6500 For hearing impaired with TDD, call…1-800-822-6268

ARE YOU SUBJECT TO NONRESIDENT WITHHOLDING?

Payments made to nonresident payees, including corporations, individuals, partnerships, estates and trusts, are subject to withholding. Nonresident payees performing services in California or receiving rent, lease or royalty payments from property (real or personal) located in California will have 7% of their total payments withheld for state income taxes. However, no withholding is required if total payments to the payee are $1500 or less for the calendar year.

A nonresident payee may request that income taxes be withheld at a lower rate or waived by sending a completed form FTB 588 to the address below. A waiver will generally be granted when a payee has a history of filing California returns and making timely estimated payments. If the payee activity is carried on outside of California or partially outside of California, a waiver or reduced withholding rate may be granted. For more information, contact:

Franchise Tax Board

Nonresident Withholding Section

Attention: State Agency Withholding Coordinator

P.O. Box 651 Sacramento, CA 95812-0651

Telephone: (916) 845-4900

FAX: (916)-845-9512

If a reduced rate of withholding or waiver has been authorized by the Franchise Tax Board, attach a copy to this form.

FOREIGN CITIZENS and FOREIGN BUSINESSES

Federal tax withholding regulations differ significantly from California tax withholding requirements. Certain information is required in order to obtain a proper tax analysis. Please note that the University cannot process any payments without this information. Please contact Cal State San Marcos at 760-750-4424 for the required information.

IRS website for tax analysis and forms: http://www.irs.gov

PRIVACY STATEMENT

Section 7(b) of the Privacy Act of 1974 (Public Law 93-5791) requires that any federal, state, or local governmental agency which requests an individual to disclose his social security account number shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.

The State of California requires that all parties entering into business transactions that may lead to payment(s) from the State must provide their Taxpayer Identification Number (TIN) as required by the State Revenue and Taxation Code, Section 18646 to facilitate tax compliance enforcement activities and to facilitate the preparation of Form 1099 and other information returns as required by the Internal Revenue Code, Section 6109(a). The TIN for individual and sole proprietorships is the Social Security Number (SSN).

It is mandatory to furnish the information requested. Federal law requires that payments for which the requested information is not provided be subject to a 31% withholding and state law imposes noncompliance penalties of up to $20,000.

You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.

Please call the Department of Finance, Fiscal Systems and Consulting Unit at (916) 324-0385 if you have any questions regarding this Privacy Statement. Questions related to residency or withholding should be referred to the telephone numbers listed above. All other questions should be referred to the requesting agency listed in Section 1.

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