CDTFA-549-S REV. 3 (6-21)                                                                                 STATE OF CALIFORNIA
CLAIMED INCORRECT DISTRIBUTION OF                         CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
LOCAL TAX — SHORT FORM
Instructions: This claim must contain sufficient factual data to support the probability that local tax has been 
erroneously allocated and distributed. Sufficient factual data must include, at a minimum, all of the information below 
for each business location being questioned. Please submit the completed claim via email to:  
LRB-PetitionInquiry@cdtfa.ca.gov. 
1) Taxpayer name, including owner name and fictitious business name or DBA (doing business as) designation.  
2) Taxpayer’s permit number or a notation stating: “no permit number.” 3) Taxpayer’s business address. 4) Complete 
description of taxpayer’s business activity(ies). 5) Specific reasons and evidence why the taxpayer’s allocation is 
questioned. In cases where it is reported that the location of the sale is an unregistered location, evidence must be 
submitted that the unregistered location is a selling location, as explained by Regulation 1699, or is a place of sale, as 
determined under Regulation 1802. In cases that involve shipments from an out-of-state location and a claim that the 
tax is sales tax and not use tax, evidence must be submitted that there was participation by an in-state office of the 
out-of-state retailer and that title to the goods passed in this state. 6) Name, title, and telephone number for a contact 
person. 7) The tax reporting period(s) involved.

NAME OF JURISDICTION                                                      ALLOCATION PERIOD(S) IN QUESTION

REASON FOR QUESTIONING THE ALLOCATION

                                               SECTION I — GENERAL BUSINESS INFORMATION
OWNER NAME                                                BUSINESS NAME

BUSINESS ADDRESS (street, city, state ZIP code)

CALIFORNIA SELLER’S PERMIT NUMBER              DATE BUSINESS STARTED      CURRENTLY OPERATING
                                                                           Yes                 No
DESCRIPTION OF OPERATION OF BUSINESS

                     Contact person for more information regarding the taxpayer’s allocation of local tax:
NAME                                                      TITLE

DAYTIME TELEPHONE NUMBER                                                  BEST TIME TO CALL

MAILING ADDRESS (street, city, state ZIP code)            EMAIL ADDRESS

                                               SECTION II — QUESTIONS ABOUT THE BUSINESS
Has this business changed locations?            Yes   No
If yes, list previous address and dates of operation:
ADDRESS (street, city, state ZIP code)

DATES OF OPERATION
From:                                   To: 

                                                    CLEAR            PRINT