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TAXABLE YEAR Nonresident Withholding 0 CALIFORNIA FORM 2016 Allocation Worksheet 587 The payee completes this form and returns it to the withholding agent. Part I Withholding Agent name Ana Address (apt)sta., room, PO box, or FMB no.) 20 Civic Center Plaza M-16 City (If you have a foreign address, see Instructions.) State ZIP code Santa Ana CA 1 92701 Part II Nonresident Payee ❑ Payee's name SSN or ITIN IR FEIN ❑ CA Corp no. ❑ CA SOS file no. The Olson Group, LTD Address (apt./ste., room, PO box, or PMB no.) 300 North Washington Street, Suite 600 City (If you have a foreign address, see instructions.) State I ZIP code VA 1 22314 Nonresident payee's entity type: (Check one) ❑Individual/sole proprietor ®Corporation ❑Partnership ❑Limited liability company(LLC) El Estate or trust Part III Nonresident payee: (Check one) ❑ Performs services totally outside California (no withholding required, skip to ❑ Provides goods and services In California (see Part IV, Income Allocation) Certification of Nonresident Payee) ® Provides services within and outside California (see Part IV, Income Allocation) ❑ Provides only goads or materials (no withholding required, skip to ❑ Other (Describe) Certification of Nonresident Payee) If the nonresident payee performs all the services within California, withholding Is required on the entire payment for services unless the payee is granted a withholding waiver from the Franchise Tax Board (FTB). For more information, get FTB Pub. 1017, Resident and Nonresident Withholding Guidelines. Part IV Income Allocation Gross payments expected from the withholding agent during the calendar year for: (a) Within California (b) Outside California (c) Total payments 1 Goods and services: Goods/materials (no withholding required) ..... ... ..... ............. ............. ................. Services (withholding required) ....... .... _ $0.00 $3,000,000.00 $3,000,000.00 2 Rents or lease payments .... ...... ... .. 3 Royalty payments ... ............ .... .. 4 Prizes and other winnings ............... _ - 5 Other payments .......................... 6 Total payments subject to withholding. Add column (a), line 1 through line 5 . ..... $0.00 $3,000,000.00 _ $3,000,000.00 Nonresident withholding threshold amount:... $1 500.00 Backup withholding threshold amount:....... of Nonresident Payee To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to flb.ca.goy and search for privacy notice. To request this notice by mail, call 800. 852,5711, Under penalties of perjury, I certify that the Information provided on this document is true and correct. If the reported facts change, I will promptly inform the withholding agent. Print or type payee's name Telephone Kyle B. Olson, Preside n ( 703 ) 518-9982 Sign Payee' Date Heave D' August 31 2016 OF tr presentalive's name and title yp Telephone Authorized representatives signature Date III, ® 7041163 I— Form 587c2 2015