Form CDTFA-507-TEA "Emergency Telephone Users Surcharge - Refusal to Pay Schedule" - California

What Is Form CDTFA-507-TEA?

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 January 1, 2020;
  • 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-507-TEA 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-507-TEA "Emergency Telephone Users Surcharge - Refusal to Pay Schedule" - California

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CDTFA-507-TEA (FRONT) REV. 3 (1-20)
STATE OF CALIFORNIA
EMERGENCY TELEPHONE USERS SURCHARGE —
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
REFUSAL TO PAY SCHEDULE
Page
of
GENERAL INFORMATION: This schedule is required to be filled out by service suppliers/prepaid MTS sellers and submitted to the CDTFA as mandated by Revenue and Taxation
Code (R&TC) 41024 of the Emergency Telephone Users Surcharge Law. Use this schedule to report any service users/prepaid consumers who refused to pay a cumulative total
of $3.00 or more in surcharges. You must include the name and address of every service user/prepaid consumer who refused to pay, the amount they owe, and their reason for
refusing to pay the surcharge if known (R&TC 41024). Enclose the completed schedule with your CDTFA-501-TE, Emergency Telephone Users Surcharge Return, and submit via
email or mail to the address indicated on this form.
ACCOUNT NAME
ACCOUNT NUMBER
REPORTING PERIOD
NAME
MAILING ADDRESS
CITY
STATE
ZIP
AMOUNT REFUSED
REASON FOR REFUSAL TO PAY
TO BE PAID
(IF KNOWN)
1
$
$
2
$
3
$
4
$
5
$
6
$
7
$
8
$
9
$
10
$
11
$
12
$
13
$
14
$
15
$
16
$
17
$
18
$
19
TOTAL $
0.00
Mail the completed schedule to: CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION, RETURN PROCESSING BRANCH
MIC:88, PO BOX 942879, SACRAMENTO, CA 94279-0088 or email to BTFDPCDETUSSched@cdtfa.ca.gov.
Make a copy of this document for your records.
CLEAR
PRINT
CDTFA-507-TEA (FRONT) REV. 3 (1-20)
STATE OF CALIFORNIA
EMERGENCY TELEPHONE USERS SURCHARGE —
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
REFUSAL TO PAY SCHEDULE
Page
of
GENERAL INFORMATION: This schedule is required to be filled out by service suppliers/prepaid MTS sellers and submitted to the CDTFA as mandated by Revenue and Taxation
Code (R&TC) 41024 of the Emergency Telephone Users Surcharge Law. Use this schedule to report any service users/prepaid consumers who refused to pay a cumulative total
of $3.00 or more in surcharges. You must include the name and address of every service user/prepaid consumer who refused to pay, the amount they owe, and their reason for
refusing to pay the surcharge if known (R&TC 41024). Enclose the completed schedule with your CDTFA-501-TE, Emergency Telephone Users Surcharge Return, and submit via
email or mail to the address indicated on this form.
ACCOUNT NAME
ACCOUNT NUMBER
REPORTING PERIOD
NAME
MAILING ADDRESS
CITY
STATE
ZIP
AMOUNT REFUSED
REASON FOR REFUSAL TO PAY
TO BE PAID
(IF KNOWN)
1
$
$
2
$
3
$
4
$
5
$
6
$
7
$
8
$
9
$
10
$
11
$
12
$
13
$
14
$
15
$
16
$
17
$
18
$
19
TOTAL $
0.00
Mail the completed schedule to: CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION, RETURN PROCESSING BRANCH
MIC:88, PO BOX 942879, SACRAMENTO, CA 94279-0088 or email to BTFDPCDETUSSched@cdtfa.ca.gov.
Make a copy of this document for your records.
CLEAR
PRINT