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TAXABLEYrAR _ CALIFORNIA FORM <br /> 2020 illng Exe!jptllon 590 <br /> The payea completes this farm and submits It to the withholding agent,The withholding agent kaltps this form with their records. <br /> Withholding Agent Information <br /> Marna <br /> CITY OF SANTA ANA <br /> Pavea Iran t�a�ion <br /> Nam ❑88N or ITIN 11 FEIN 13 CAA Corp no.El CA 808 rile no. <br /> e d <br /> r °t 0_fC'{✓ sec VI q <br /> Add r sic.,room,PO bax.or744.1 <br /> C)(t <br /> e— 400 <br /> Gily ynu heavLllmelgn address,see insteu na.)azt, <br /> Exemption Reason <br /> Check only one box. <br /> By checking the appropriate box below,the payee certifies the reason for the exemption from the Callfornla Income tax withholding <br /> requirements on payment(s)made to the entity or individual. <br /> ® Individuals---Certification of Residency: <br /> I am a resident of California and I reside at the address shown above.If I become a nonresident at any time,I will promptly <br /> notify the withholding agent.See instructions for General Information D,Definitions. <br /> ❑ Corporations: <br /> The corporation has a permanent place of business in California at the address shown above or Is qualified through the <br /> California Secretary of State(SOS)to do business in California.The corporation will file a California tax return.If this <br /> corporation ceases to have a permanent place of business in Caiifornia or ceases to do any of the above,I will promptly notify <br /> the withholding agent.See instructions for General Information D,Definitions. <br /> ❑ Partnerships or Limited Liability Companies <br /> The partnership or LLC has a permanent place of business in California at the address shown above or is registered with the <br /> California SOS,and Is subject to the laws of California,The partnership or LLC will file a California tax return.If the partnership <br /> or LLC ceases to do any of the above, I will promptly inform the withholding agent.For withholding purposes,a Ilmlted liability <br /> partnership(LLP)is treated like any other partnership. <br /> ide/nx-Exernpt Entitlaw (p 5 17' (70 <br /> The entity is exempt from tax under Calif rnis Revenue and Taxation ®(R&TC)Section 23701 (insert letter)or <br /> Internal Revenue Code Section 504(c)_(Insert number),If tills entity ceases to be exempt from tax,I will promptly notify <br /> the withholding agent. Individuals cannot be tax-exempt entities. <br /> ❑ Insurance Companies,Individual Rotiremerat Arrangements(IRAs),or Qualified Pension/Profit-Sharing plans: <br /> The entity is an insurance company, IRA,or a federally qualified pension or profit-sharing plan. <br /> calffornia Trusts: <br /> At least one trustee and one noncontingent beneficiary of the above-named trust Is a California resident.The trust will file a <br /> California fiduciary tax return.If the trustee or noncontincgent beneficiary becomes a nonresident at any time, I will promptly <br /> notify the withholding agent. <br /> ❑ Estates—Co$tification of Residency of Deceased Person: <br /> am the executor of the above-named person's estate or trust.The decedent was a California resident at the time of death. <br /> The estate will file a Californla fiduciary tax return. <br /> ❑ Nonmilitary Spouse of a Military Serviceme ber: <br /> I am a nonmilitary spouse of a military servicamember and I meet the Military Spouse Residency Belief Act(MSRRA) <br /> requirements.See Instructions for General Information E,MSRRA, <br /> CERTIFICATE OF PAYEE:Payee must complete and sign below. <br /> To learn about your privacy rights,how we may use your Information, and the consequences for not providing the requested information, <br /> go to ftb.ca.govlforms and search for 1131,To request this notice by mall,call 800.852,5711. <br /> Linder penalties of perjury, I declare that I have examined the information on this form, including accompanying schedules and <br /> statements,and to the best of my knowledge and belief,It is true,correct,and complete.I further declare under penalties of perjury that <br /> If the facts upon which tfris form are bas hange, I will romptl notify the withh ding agent. <br /> 'type or print payee's name a e f` /kP Tel � (LZ �5F <br /> Payee's signature® Date � <br /> '7061.203 Form 590 2019 <br />