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STATE OF CALIFORNIA-MPAnTMENT OF FINANCE
<br />PAYEE DATA RECORD
<br />(Required when receiving paymentfrom the State of California In lieu of IRS W-9 or W 7)
<br />STD 2.04 (Nov. 4/2017)
<br />Roquiramont ko Complete the Payee Data Record, STD 2"
<br />A completed Payee Data Record, STD 204 form, is required for all payees (nongovernmental entities or Individuals) entering into
<br />a transaction that may load to a payment from the state. Each state agency requires a completed, slgnod, and dated STD 704 on
<br />file; therefore, it is possible for you to receive this form from multiple state agencies with which you do business,
<br />Payees who do not wish to complete the STD 204 may elect not to do business with the state. If the payee does not complete the
<br />$TD 204 and the required payee data is not otherwise provided, payment may be reduced for federal and state hookup
<br />withholding, Amounts reported on Information Rotuma (Form 1099) are in accordance with the Interne] Revenue code (IRC) and
<br />the California Revenue and Taxation Code (RUC),
<br />Entortho payee's legal business name. The name must match the name on the payee's tax return as filed with the federal
<br />Internal Revenue Service. Sole proprietorships must also Include the owner's full name. An Individual must list his/her full name
<br />as shown on the SSN or as entered on the W-7 form for ITIN.
<br />'rho mailing address should be the address at which the payee chooses to receive correspondence (Le. 1090 form) and
<br />payments. The business address Is the address of the buslness' physlosl location; do not enter the payment address or lock box
<br />information here. -
<br />Chock only one box that corresponds to the payee business type, Corporations must chock the box that identifies the type of
<br />corporation.
<br />The State of California requires that all parties entering Into business transactions that may lead to paymard(s) from the state
<br />provide their Taxpayer Identification Number (TIN). The TIN Is required by the R&TC sections 18646 and 18601 to facilitate tax
<br />complisnos enforcement activities and the preparation of Form 1099 and other information returns as required by the IRC section
<br />6109(a) and R&TC section 18662 and Its regulations.
<br />Payees must provide one of the following TINS an this form: social security n6inber ISSN), Individual taxpayer identification
<br />number (ITIN), or fedora] employer Identification number (MIN). The TIN for sole pmpriatorsh]ps and individuals is the SSN or
<br />ITIN. Only partnerships, estates, trusts, and corporations will enter their KIN,
<br />Are you a California resident or nonresiden47�
<br />d�
<br />A corporation will be defined as a "resident" If It has a permanent place of business IreCallfornia or is qualified through the
<br />Secretary of State to do business In California.
<br />A partnership is considered a resident partnership if It has a permanent place of business in California. An estate is a resident if
<br />the decedent was a California resident at time of death, A trust ]so resident If at least one trustee is a California resident.
<br />For individuals and sole proprietors, the ten "resident' includes every individual who is in California for other than a temporary or
<br />transitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an
<br />individual who comes to California for a purpose that will extend over a long or indefinite period will be considered a resident.
<br />However, an individual who comes to perform a particular contract of short duration will be considered a nonresident.
<br />Payments to all nonresidents may be.subject to withholding. Nonresident payees performing services in California or receiving
<br />rent, lease, or royalty payments from property (real or personal) located in California will have 7% of their total payments
<br />withheld for state Income taxes. However, no withholding is required it total payments to the payee are $1,500 or less for the
<br />calendar year.
<br />For information on Nonresident Withholding, contact the Franchise'rax Board at the numbers listed below:
<br />.
<br />Withholding Services and Compliance Section: 1.886-792-4900 Email address: wsee.gan@ftb.ca.gov
<br />For hearing Impaired with TOE), call 1-800-822-0268 Webaite: wvwa aa.ga
<br />Provide the name, title, email address, signature, and telephone number of the Individual completing this form, Provide the data
<br />the form was completed.
<br />This section must be completed by the state agency requesting the STD 204,
<br />Prlveay Statement
<br />Section 7(b) of the Privacy Act of1974 (Public Law W-579) requires that any federal, state, or local governmental agency, which requests an
<br />individual to disclose their social security account number, shall Inform that individual whether that disclosure is mandatory or voluntary, by
<br />which statutory or other outhadty'such number Is solicited, and what uses will be made of it
<br />It is mandatory to turnlah the information requested, Federal law requires that payment for which the requested Information is not provided Is
<br />subject to federal backup withholding and state law Imposes noncompliance penalties of up to $20,000,
<br />You have the right to access records containing your personal information, such as your SSN, To exercise that right, please contact the
<br />business services unit or tho. accounts payable unit of the state agency(les) with which you transact that business.
<br />All,questions should be referred to the requesting state agency listed on the bottom front of this form,
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