Form CDTFA-245-CAD "Cash Payment Dispute" - California

What Is Form CDTFA-245-CAD?

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 February 1, 2018;
  • 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-245-CAD 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-245-CAD "Cash Payment Dispute" - California

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CDTFA-245-CAD (FRONT) (2-18)
STATE OF CALIFORNIA
CASH PAYMENT DISPUTE
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
If you wish to dispute a credit for your cash payment made with “Deposit Bags” dropped off at a California Department of Tax
and Fee Administration (CDTFA) office, please complete and sign this dispute form. This completed form and supporting
documentation, including the applicable CDTFA receipt for this transaction, must be returned to the office where you made the
cash payment within 10 business days from the date the CDTFA verified your payment.
Instructions on back
SECTION I – TAXPAYER/FEEPAYER INFORMATION
NAME OF TAXPAYER(S) OR FEEPAYER(S)
CDTFA ACCOUNT NUMBER (only list one account number per dispute)
BUSINESS NAME
BUSINESS ADDRESS
MAILING ADDRESS
SECTION II – PAYMENT INFORMATION
DATE OF PAYMENT
TIME OF PAYMENT
OFFICE ADDRESS (where payment was made)
AMOUNT OF PAYMENT
AMOUNT VERIFIED
DIFFERENCE
CDTFA RECEIPT NUMBER (received from CDTFA when bag was dropped off)
BASIS FOR DISPUTE (required)
SECTION III – PREPARER/CONTACT INFORMATION
PREPARER’S NAME
SIGNATURE
DATE SIGNED
PREPARER’S TITLE OR POSITION
EMAIL ADDRESS
TELEPHONE NUMBER
CONTACT PERSON (if other than signatory)
SIGNATURE
DATE SIGNED
CONTACT PERSON’S TITLE OR POSITION
EMAIL ADDRESS
TELEPHONE NUMBER
CLEAR
PRINT
CDTFA-245-CAD (FRONT) (2-18)
STATE OF CALIFORNIA
CASH PAYMENT DISPUTE
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
If you wish to dispute a credit for your cash payment made with “Deposit Bags” dropped off at a California Department of Tax
and Fee Administration (CDTFA) office, please complete and sign this dispute form. This completed form and supporting
documentation, including the applicable CDTFA receipt for this transaction, must be returned to the office where you made the
cash payment within 10 business days from the date the CDTFA verified your payment.
Instructions on back
SECTION I – TAXPAYER/FEEPAYER INFORMATION
NAME OF TAXPAYER(S) OR FEEPAYER(S)
CDTFA ACCOUNT NUMBER (only list one account number per dispute)
BUSINESS NAME
BUSINESS ADDRESS
MAILING ADDRESS
SECTION II – PAYMENT INFORMATION
DATE OF PAYMENT
TIME OF PAYMENT
OFFICE ADDRESS (where payment was made)
AMOUNT OF PAYMENT
AMOUNT VERIFIED
DIFFERENCE
CDTFA RECEIPT NUMBER (received from CDTFA when bag was dropped off)
BASIS FOR DISPUTE (required)
SECTION III – PREPARER/CONTACT INFORMATION
PREPARER’S NAME
SIGNATURE
DATE SIGNED
PREPARER’S TITLE OR POSITION
EMAIL ADDRESS
TELEPHONE NUMBER
CONTACT PERSON (if other than signatory)
SIGNATURE
DATE SIGNED
CONTACT PERSON’S TITLE OR POSITION
EMAIL ADDRESS
TELEPHONE NUMBER
CLEAR
PRINT
CDTFA-245-CAD (BACK) (2-18)
INSTRUCTIONS FOR COMPLETING CASH PAYMENT DISPUTE
When submitting a dispute, you must provide the date, time, the payment amount, the location of the payment, and the
basis for dispute within 10 business days from the date the CDTFA verified your payment.
How You Can Submit Your Claim
Mail, email, fax, or deliver in person (as applicable), this form to the local office where your cash payment was made.
You may only list one account number per dispute form.
SECTION I – TAXPAYER/FEEPAYER INFORMATION
Name of Taxpayer or Feepayer and CDTFA Account Number: Enter the name(s) and account number as
registered with the CDTFA of the account where a cash payment amount is in dispute.
Business Name and Address: Enter the name of the business (for example, if the taxpayer name of the account is
John Doe and the business’s name (DBA) is XYZ Auto Repair, XYZ Auto Repair should be entered).
Mailing Address: Enter the taxpayer/feepayer’s mailing address.
SECTION II – PAYMENT INFORMATION PROVIDED BY TAXPAYER/FEEPAYER
Date and Time of Payment: Enter the date and time the “deposit bag” was dropped off at CDTFA and a CDTFA
receipt was received.
Office Address: Enter the local CDTFA office address where you made your payment.
Amount of Payment: Enter the amount you entered on your CDTFA-705, Currency Deposit, form that is the
amount you stated you paid.
Amount Verified: Enter the amount the CDTFA verified and gave your account credit for.
Difference: Enter the difference between the Amount of Payment and the Amount Verified.
CDTFA Receipt Number – Enter the CDTFA receipt number and please
provide a copy with your completed form.
Basis for Dispute (required): Provide the basis or grounds for the dispute or describe the circumstances.
SECTION III – PREPARER/CONTACT INFORMATION
Preparer’s Name and Signature: The preparer of the dispute form must print and sign his or her name.
Date Signed: Enter the date the dispute form is signed.
Title or Position: The preparer must include his or her title or position (for example, bookkeeper, attorney, owner,
accountant, taxpayer, etc.).
Email: The preparer must include his or her email address.
Telephone Number: The preparer must include his or her telephone number.
Contact Person’s Name and Signature (if other than signatory): This line may be used to designate a person (other
than the signatory) to contact, should the CDTFA have questions or require additional information. Such persons may
be employees, consultants, accountants, attorneys, etc., as designated by the taxpayer or feepayer.
Date Signed by Contact Person: Enter the date the dispute form is signed.
Contact Person’s Email: The contact person must include his or her email address.
Telephone Number: The contact person must include his or her telephone number.
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