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STATE OF CALIFORNIA | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29
PAYEE DATA RECORD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Vendor #:
(Required in lieu of IRS W-9 when doing business with the State of California) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | CMA - Use Only               ­
STD. 204 (CMA Rev. 5-08)
NOTE:  Governmental entities, federal, state, and local (including public school districts) are not required to submit this form.
 |  |  |  |  | DEPARTMENT/OFFICE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PURPOSE:  Information contained in this form will be used by state agencies to prepare information Returns (Form 1099) and for withholding on payments to nonresident payees.  Prompt return of this fully completed form will prevent delays when processing payments.                                                                                            (See Privacy Statement on reverse)
 | 1 |  |  |  | THE CALIFORNIA MARITIME ACADEMY-Accounting
 |  |  |  |  | STREET ADDRESS
PLEASE RETURN TO: |  |  |  |  | 200 Maritime Academy Drive
 |  |  |  |  | CITY, STATE, ZIP CODE
 |  |  |  |  | Vallejo, CA   94590
® ® ® ® |  |  |  |  | TELEPHONE NUMBER
 |  |  |  |  | Voice: |  |  | [PHONE] |  |  |  |  |  |  | Fax: |  | [PHONE]
 |  |  |  |  | PAYEE’S LEGAL BUSINESS NAME |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PAYEE ACTIVITYCheck All Boxes That Apply
 | 2
 |  |  |  |  | SOLE PROPRIETOR – ENTER OWNER’S FULL NAME AS SHOWN ON SSN (Last, First, M.I.)
 |  | DVBE
 |  |  |  |  | MAILING ADDRESS (Number and Street or P.O. Box #) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | EMAIL ADDRESS
 |  | OSB
 |  |  |  |  | CITY, STATE, ZIP CODE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PAYEE PHONE & FAX NUMBER
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NOTE
 | 3 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | -Government Entities
PAYEE        ENTITY       TYPE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | -CMA Employees
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | are not required to sign this form
 | 4 |  |  |  | SOCIAL SECURITY NUMBER REQUIRED FOR INDIVIDUAL/SOLE PROPRIETOR BY AUTHORITY OF REVENUE AND TAXATION CODE SECTION 18646 (See reverse)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Payment will not be processed without an accompanying taxpayer I.D. number.
 |  |  |  |  |  | FEDERAL EMPLOYERS IDENTIFICATION (FEIN) |  |  |  |  |  |  |  |  |  |  |  | SOCIAL SECURITY NUMBER / ITIN
 |  |  |  |  |  |  |  |  | - |  |  |  |  |  |  |  |  |  |  |  | - |  |  | -
 |  |  |  |  |  |  | IF PAYEE ENTITY TYPE IS A CORPORATION, PARTNERSHIP, ESTATE OR TRUST, ENTER FEIN. |  |  |  |  |  |  |  |  |  |  | IF PAYEE ENTITY TYPE IS INDIVIDUAL OR SOLE PROPRIETOR, ENTER SSN. Enter SSN or ITIN IF RESIDENT OF FOREIGN COUNTRY.
 |  |  |  |  |  | Section 5:  Check All Boxes That Apply |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NOTE: Prior to making payments to foreign citizens,   United States tax laws require all employers to perform a tax analysis with respect to country of citizenship to determine residency for Federal tax purposes. (Please See Reverse)
 | 5 |  |  |  |  | Federal Income Tax Withholding Status:
 |  |  |  |  |  |  | I Am a US Citizen |  |  |  |  |  |  | I Am a Permanent Resident Alien and I Have a Green Card
PAYEE RESIDENCY DECLARATION      For Tax         Purposes All Payments Made By The University Are Subject To Federal  and California State          Tax Laws
 |  |  |  |  |  |  | I Am Not a U.S. Citizen and I Do Not Have a Permanent Resident Green Card    Note: All  Foreign Citizens must complete a tax analysis before payments can be made.
 |  |  |  |  |  |  | Tax Exempt by Tax Treaty |  |  |  |  |  |  |  | Country of Residency:
 |  |  |  |  |  | California State Tax Withholding Status: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NOTE: An estate is a resident if decedent was a California resident at time of death. A trust is resident if one or more trustees are CA residents.  Rules for assessing State taxes differ significantly from Federal tax rules. (Please See Reverse)
 |  |  |  |  |  |  | California Resident Qualified to do business in CA or maintains a permanent place of business in CA.
 |  |  |  |  |  |  | California Nonresident (See Reverse). Payments to CA nonresidents may be subject to state income tax withholding.
 |  |  |  |  |  |  |  |  | A Waiver from CA state tax withholding is attached (From the California Franchise Tax Board).
 |  |  |  |  |  |  |  |  | All services related to this payment were performed OUTSIDE of the state of California.
 | 6 |  |  |  | Are you or any of your employees (current/previously) employed by the CSU?    YES _____   NO _____  If yes, provide employee name(s) and relationship as an attachment to this STD. 204 Form.
 |  |  |  |  |  | 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.
 | 7
 |  |  |  |  | AUTHORIZED PAYEE REPRESENTATIVE'S NAME & TITLE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | BUSINESS EMAIL ADDRESS
CERTIFYING SIGNATURE
 |  |  |  |  | SIGNATURE |  |  |  |  |  |  |  |  |  |  |  |  | DATE |  |  |  | PH & FAX NUMBER
STATE OF CALIFORNIA
PAYEE DATA RECORD
STD. 204 (CMA REV. 01-2008) (REVERSE)
ARE YOU A RESIDENT OR NONRESIDENT? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | ARE YOU SUBJECT TO NONRESIDENT WITHHOLDING?
Each corporation, individual/sole proprietor, partnership, estate, or trust doing business with the State of California must indicate residency status along with their payee identification number. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Payments made to nonresident vendors including corporations, individuals, partnerships, estates and trusts are subject to income tax withholding. Nonresident vendors 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 California tax withholding is required if total payments to the payee are $1,500 or less for the calendar year.
A corporation 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.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 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:
For individual/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 nonresident.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Franchise Tax Board
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Withhold at Source Unit
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Attention: State Agency Withholding Coordinator
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] 651
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Sacramento, CA 95812-0651
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Telephone: [PHONE]
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 on trustee is a California resident. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Fax: [PHONE]
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | E-mail Address: [EMAIL]
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Website: www.ftb.ca.gov
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | If a reduced rate of withholding or waiver has been authorized by the Franchise Tax Board, attach a copy to this form.
More information on residency status can be obtained by calling the Franchise Tax Board at the numbers listed below: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FOREIGN CITIZENS and FOREIGN BUSINESSES
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Federal tax withholding regulations differ significantly from California tax withholding requirements. A tax analysis consultation and additional forms must be completed before a payment can be released
From within the United States, call [PHONE] From outside the United States, call [PHONE]    For hearing impaired with TDD, call [PHONE]
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 Revenue and Taxation Code Section 18646, to facilitate tax compliance enforcement activities and preparation of Form 1099 and other information returns as required by Internal Revenue Code Section 6109(a). The TIN for individuals and sole proprietorships is their 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 is subject to withholding and state law imposes noncompliance penalties 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.