CDTFA-65 (FRONT) REV. 33 (8-18)                                                                                      STATE OF CALIFORNIA 
NOTICE OF CLOSEOUT                                          CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION 
INSTRUCTIONS: Please provide the following information to assist us in closing your account(s), releasing security, or issuing an 
escrow clearance. If you have a seller’s permit, before completing this form, you should refer to a copy of the California Department 
of Tax and Fee Administration (CDTFA) publication 74, Closing Out Your Account. Publication 74 contains important information about 
closing out your permit. If you have any questions, please call our Customer Service Center at 1-800-400-7115 (TTY:711). 

     CDTFA Use Only
     CDTFA Use Only
     CDTFA Use Only

SECTION  I:  ACCOUNT  INFORMATION 
NAME                                                                                       ACCOUNT  NUMBER(S) 

CURRENT ADDRESS  (street address)                                                          DA YTIME TELEPHONE NUMBER 

CITY                                                            STATE                      ZIP  CODE 

SECTION  II:  CLOSEOUT  INFORMATION  (see back for instructions) 
1. Date business was closed
2. Did you make any purchases for your own use using your seller’s permit?  YES             NO  
If YES, did you pay tax on those purchases to:        a. your vendor     b. the CDTFA
3. Do you have a prepaid Mobile Telephony Services (MTS) account? YES               NO 
a.      Date you discontinued selling prepaid phone cards and/or services
b.      If you qualify as a small seller, date you want your account closed out
4. Your forwarding address and telephone number

5. Location of your books and records
6. Was the business sold?   YES      NO 
a.      Date the business was sold
b.      Total sales price $
c.      Name, address, and telephone number of the purchaser

d.                                                       YES    NO   If no, proceed to line h. 
e.                                  
f.      Did                                                              YES             NO 
g.      If not, provide address for the place of business where the sale took place

          a.Note:                                                                                                                        
                                                                                   Tax”.   
h.      Escrow number
i.      Name, address, and telephone number of escrow company

SECTION   III:   SIGNATURE 
SIGNATURE                            PRINT  NAME AND  TITLE                                                    DATE 

                                                      CLEAR     PRINT

CDTFA-65 (BACK) REV. 33 (8-18) 
NOTICE OF CLOSEOUT 

SECTION   IV:   LIST   OF   ITEMS   NEEDED   FOR   CLOSEOUTS 
                                                                                                                                    
escrow clearance. 
 •      Payments of any other outstanding balances due.
 •      Y                                                                                                 (TTY:711).                     
                                                                                ,                                                             
                                                                    process.   
 •      A                                                                                                                     
                               Send this completed form and your supporting documents to: 
                                      California Department of Tax and Fee Administration 
                                                 Customer Service Center  
                                                          PO Box 942879 
                                                 Sacramento, CA 94279-0090   

 SECTION   V:    INSTRUCTIONS 

If the items listed below do not pertain to your closeout and you have completed Sections I and II, and signed in Section III, 
send this document to the appropriate CDTFA office. See publication 74 for a list of CDTFA office locations.   
Small Sellers–A                                                                                                                      
annual threshold of sales of prepaid MTS in the previous calendar year. Beginning January 1, 2017, small sellers are no longer required 
to charge and collect the prepaid MTS surcharge from their customers. For sellers that have more than one location, the sales of 
prepaid wireless services and products from all locations must be used to determine their annual sales. Small sellers are responsible 
for maintaining records to show that their annual sales are below the annual threshold. 
Location of your books and records–The location of your books and records is important for audit purposes. Audits are important 
because they protect the state against an underpayment and protect the taxpayer against an overpayment. 
Copy of your escrow instructions or bill of sale                                                                                           
                                                                                                                                              
1. The sale occurs within 60 days of the date of closeout and the taxpayer cannot establish that the sale was not contemplated at the
 time of closeout; or
2. The sale takes place after 60 days and within one year of the closeout date, and:
 a. A contract of sale existed at the date of closeout, or
 b. A lease with an option to buy exists, or
 c.                                                                                                            
If these items are not provided, the CDTFA must wait 30 days before refunding any security deposits posted and/or closing 
your account. If you need assistance in providing any of the items listed above, contact your nearest CDTFA office for detailed 
instructions.   

                                                 FOR  CDTFA  USE  ONLY 

 Is registration information current?       YES            NO                            F&E?                              YES     NO  

                                            YES            NO                            Inventory?                        YES     NO  

 W                                          YES            NO                            Is the documentation attached?    YES     NO  

 Are there any delinquencies?               YES            NO                            Unapplied payment?                YES     NO