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ATE PERIOD END DATE EFF YOUR ACCOUNT NUMBER PM READ INSTRUCTIONS BEFORE PREPARING CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION PO BOX 942879 SACRAMENTO, CA 94279-8004 Please check this box if this filing represents an AMENDED RETURN. You can file online. Payment by credit cards is accepted. Please see instructions for further details. PLEASE ROUND CENTS TO THE NEAREST WHOLE DOLLAR 1 Total (gross) sales 1 $ .00 2 Purchases subject to use tax 2 .00 3 Total (add lines 1 and 2).

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