RFP No: FSO-2017-10-JR East County Regional Center Elevator-ModernizationATTACHMENT 7
STATEOFCALIFORNIA-DEPARTMENTOFFINANCE
PAYEEDATARECORD
(RequiredwhenreceivingpaymentfromtheStateofCaliforniainlieuofIRSW-9)
STD.204 (Rev. 6-2003)
INSTRUCTIONS:Completeallinformationonthisform.Sign,date,andreturntotheStateagency(department/office)addressshownat1 thebottomofthispage. Promptreturnofthisfullycompletedform willpreventdelays whenprocessingpayments.InformationprovidedinthisformwillbeusedbyStateagenciestoprepareInformationReturns(1099). SeereversesideformoreinformationandPrivacyStatement.
NOTE:Governmentalentities,federal,State,andlocal(includingschooldistricts),arenotrequiredtosubmitthisform.
2 / PAYEE’SLEGALBUSINESSNAME(TypeorPrint)
SOLEPROPRIETOR–ENTERNAME ASSHOWNONSSN(Last,First,M.I.) / E-MAILADDRESS
MAILINGADDRESS / BUSINESSADDRESS
CITY,STATE,ZIPCODE / CITY,STATE,ZIPCODE
3
PAYEEENTITYTYPE / ENTERFEDERAL EMPLOYER IDENTIFICATIONNUMBER(FEIN): –
PARTNERSHIP CORPORATION:
D MEDICAL(e.g.,dentistry,psychotherapy,chiropractic,etc.)
ESTATEOR TRUST D LEGAL(e.g., attorneyservices)
D EXEMPT(nonprofit)
D ALLOTHERS / NOTE:
PaymentwillnotbeprocessedwithoutanaccompanyingtaxpayerI.D.number.
CHECK
ONEBOXONLY / INDIVIDUALORSOLE PROPRIETOR – –ENTERSOCIALSECURITYNUMBER:
(SSNrequired byauthority ofCalifornia Revenueand TaxCodeSection18646)
4
PAYEERESIDENCYSTATUS / California resident - Qualifiedtodo business inCaliforniaormaintains a permanentplace ofbusiness inCalifornia.
California nonresident (see reverse side) - Payments to nonresidents for services may besubject to State incometaxwithholding.
DNoservicesperformedinCalifornia.
D CopyofFranchiseTaxBoardwaiverofStatewithholdingattached.
5 / Iherebycertifyunderpenaltyofperjurythattheinformationprovidedonthisdocumentistrueandcorrect.
Shouldmyresidencystatuschange,IwillpromptlynotifytheStateagencybelow.
AUTHORIZEDPAYEEREPRESENTATIVE’SNAME(TypeorPrint) / TITLE
SIGNATURE / DATE / TELEPHONE
( )
6 / Pleasereturncompletedformto:
Department/Office:JudicialCouncil ofCalifornia/AdministrativeOffice oftheCourts AdministrativeDivision/Finance
Unit/Section:
455GoldenGateAvenue,6thFloor
MailingAddress:
City/State/Zip: San Francisco,CA94102-3660 Telephone: ( ) Fax: ( )
E-mailAddress:
RFP No: FSO-2017-10-JR East County Regional Center Elevator-ModernizationATTACHMENT 7
STATEOFCALIFORNIA-DEPARTMENTOFFINANCE
PAYEEDATARECORD
STD.204 (Rev. 6-2003)(REVERSE)
1 / Requirement to Complete PayeeData Record, STD.204A completed PayeeData Record, STD.204, isrequired forpaymentsto allnon-governmentalentities andwill bekept onfileateachState agency.Since each State agencywithwhichyou dobusinessmust have a separateSTD.204 on file, it ispossiblefor a payeeto receive this form from various State agencies.
Payeeswho do notwish tocomplete the STD.204 may electto notdobusinesswiththeState.Ifthe payeedoes not completetheSTD. 204andtherequired payeedata isnototherwise provided,paymentmaybe reducedforfederal backupwithholdingandnonresident State incometaxwithholding.Amountsreportedon Information Returns (1099) are inaccordancewith theInternalRevenue Codeandthe CaliforniaRevenueandTaxationCode.
2 / Enter thepayee’s legalbusiness name.Sole proprietorshipsmustalsoinclude theowner’s fullname.Anindividual mustlisthis/herfullname.The mailingaddressshould betheaddress atwhich the payeechoosestoreceive correspondence. Do notenterpayment addressorlock boxinformation here.
3 / Check the box that correspondsto the payeebusiness type.Checkonlyone box.Corporationsmustcheck the boxthatidentifiesthe typeof corporation.TheState of California requires thatall partiesenteringinto business transactions that mayleadtopayment(s) from the State provide theirTaxpayer IdentificationNumber(TIN).TheTIN is required by the California Revenue andTaxation CodeSection18646tofacilitatetax complianceenforcement activities and the preparationof Form1099 and otherinformation returnsas required bythe InternalRevenueCode Section6109(a).
TheTIN for individuals and sole proprietorships is theSocialSecurityNumber (SSN).Onlypartnerships,estates, trusts,andcorporationswill enter their FederalEmployerIdentificationNumber(FEIN).
4 / AreyouaCaliforniaresidentornonresident?
A corporationwill be defined as a "resident"ifithas a permanentplaceofbusinessinCalifornia orisqualifiedthroughthe SecretaryofState todo businessin California.
A partnership is considereda residentpartnershipifithas apermanentplaceofbusinessinCalifornia.An estateis a residentif thedecedentwas a California resident attime of death.A trustisa resident if atleast one trustee is a Californiaresident.
For individualsand soleproprietors, theterm "resident"includeseveryindividualwhois inCalifornia for other than a temporary ortransitorypurposeandany individualdomiciledinCaliforniawhoisabsentfor a temporaryor transitory purpose. Generally,anindividualwhocomes toCalifornia for a purpose thatwillextend over a long orindefiniteperiodwillbe considered a resident.
However, anindividualwhocomes toperform a particularcontractofshort durationwillbe considered a nonresident.
Payments to allnonresidentsmaybesubjecttowithholding. Nonresident payees performingservices inCalifornia orreceivingrent,lease, or royalty payments from property(realor personal) located in Californiawillhave7% of theirtotal paymentswithheld for Stateincometaxes.However,nowithholdingis requiredif totalpaymentsto thepayee are $1,500 orless forthecalendaryear.
For informationonNonresident Withholding,contact the Franchise Tax Board at the numbers listedbelow:
WithholdingServicesand ComplianceSection: 1-888-792-4900 E-mailaddress: or hearingimpairedwithTDD,call: 1-800-822-6268 Website: www.ftb.ca.gov
5 / Provide the name,title,signature, andtelephone numberof the individualcompleting this form.Providethe date theformwascompleted.
6 / This section must be completed bytheStateagency requestingthe STD.204.
PrivacyStatement
Section 7(b) of the PrivacyAct of 1974 (Public Law93-579) requires that anyfederal,State, or local governmental agency,whichrequests an individual to disclose their socialsecurityaccountnumber, shall informthat individualwhetherthat disclosure ismandatoryor voluntary, by whichstatutoryorother authority suchnumber issolicited, andwhat useswillbe made of it.
It ismandatory tofurnishtheinformationrequested. Federallawrequiresthatpayment forwhichthe requestedinformation is notprovided is subject tofederal backupwithholdingandState lawimposesnoncompliance penaltiesof upto $20,000.
You have theright toaccess recordscontainingyour personalinformation,suchasyour SSN.Toexercise thatright, pleasecontactthe business services unit or theaccounts payable unit of the Stateagency(ies)withwhichyou transact that business.
All questions should bereferred tothe requestingState agencylisted onthe bottom front of this form.