Form CDTFA-230-M-1 "Certificate of Permit Concessionaires" - California

What Is Form CDTFA-230-M-1?

This is a legal form that was released by the California Department of Tax and Fee Administration - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the California Department of Tax and Fee Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CDTFA-230-M-1 by clicking the link below or browse more documents and templates provided by the California Department of Tax and Fee Administration.

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Download Form CDTFA-230-M-1 "Certificate of Permit Concessionaires" - California

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CDTFA-230-M-1 REV. 1 (9-17)
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
CERTIFICATE OF PERMIT
CONCESSIONAIRES
Regulation 1699
I certify that I operate an independent business at the premises of the following retailer and that I hold a valid seller’s permit to
operate at this location, as noted below. I further understand that I will be solely responsible for reporting all sales that I make on
those premises and remitting all applicable sales and use taxes due to the California Department of Tax and Fee Administration:
NAME OF RETAILER ON WHOSE PREMISES I OPERATE MY BUSINESS
LOCATION OF PREMISES
I hereby certify that the foregoing information is accurate and true to the best of my knowledge:
CERTIFIER’S SIGNATURE
DATE
CERTIFIER’S PRINTED NAME
CERTIFIER’S SELLER’S PERMIT NUMBER
*
CERTIFIER’S BUSINESS NAME AND ADDRESS
CERTIFIER’S TELEPHONE NUMBER
* PLEASE NOTE: The certifier must be registered to do business at the location of the retailer upon whose premises he or she is making
retail sales.
CLEAR
PRINT
CDTFA-230-M-1 REV. 1 (9-17)
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
CERTIFICATE OF PERMIT
CONCESSIONAIRES
Regulation 1699
I certify that I operate an independent business at the premises of the following retailer and that I hold a valid seller’s permit to
operate at this location, as noted below. I further understand that I will be solely responsible for reporting all sales that I make on
those premises and remitting all applicable sales and use taxes due to the California Department of Tax and Fee Administration:
NAME OF RETAILER ON WHOSE PREMISES I OPERATE MY BUSINESS
LOCATION OF PREMISES
I hereby certify that the foregoing information is accurate and true to the best of my knowledge:
CERTIFIER’S SIGNATURE
DATE
CERTIFIER’S PRINTED NAME
CERTIFIER’S SELLER’S PERMIT NUMBER
*
CERTIFIER’S BUSINESS NAME AND ADDRESS
CERTIFIER’S TELEPHONE NUMBER
* PLEASE NOTE: The certifier must be registered to do business at the location of the retailer upon whose premises he or she is making
retail sales.
CLEAR
PRINT