Sheet 1: Cigarette Sales

	
	
	
	
	
	
	
	
	
	

		
Purchaser Name
		
Address
		
Total Price
		
Cigarette Family
		
Invoice Date
(use format mm/dd/yy)
		
Invoice Number
		
Carton UPC
		
Quantity Sold
		
Total Sticks Sold
	



Sheet 2: PA-1 (Part 2) Instructions

	
	
	
	
	
	
	

		
This workbook has 12 active worksheets - Cigarette Sales, PA-1 (Part 2) Instructions, Cigarette Delivery, PA-1 (Part 3) Instructions, Tobacco Sales, PA-2 (Part 2) Instructions, Tobacco Delivery, PA-2 (Part 3 Instructions), ENDS Sales, PA-3 (Part 2) Instructions, ENDS Delivery, and PA-3 (Part 3) Instructions.  Use the down and right arrow to navigate through the worksheet.
CDTFA-5204-PA (5-21)
		
STATE OF CALIFORNIA
	
	

		
CALIFORNIA PACT ACT REPORT ONLINE FILING TEMPLATE
		
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
		
	

		
INSTRUCTION FOR CIGARETTE SALES PA-1 (PART 2)
		
	

		
Column A
		
Purchaser Name
		
Provide your purchaser's name.
		
	

		
Column B
		
Address
		
Provide the address.
		
	

		
Column C
		
Total Price
		
Provide the total price. 
		
	

		
Column D
		
Cigarette Family
		
Provide the cigarette family (brand family). 
		
	

		
Column E
		
Invoice Date
		
Provide the invoice date. 
		
	

		
Column F
		
Invoice Number
		
Provide the invoice number. 
		
	

		
Column G
		
Carton UPC
		
Provide the carton UPC.
		
	

		
Column H
		
Quantity Sold
		
Provide the quantity sold. 
		
	

		
Column I
		
Total Sticks Sold
		
Provide the total sticks of cigarettes sold.
		
	

		
End of worksheet
For more information, visit our website at www.cdtfa.ca.gov. You may also call our Customer Service Center at 1-800-400-7115 (CRS:711); from the main menu, select the option Special Taxes and Fees. Customer service representatives are available Monday through Friday from 8:00 a.m. to 5:00 p.m. (Pacific time), except state holidays.
		
	

		
	

		
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	



Sheet 3: Cigarette Delivery

	
	
	
	

		
Delivery Service Name
		
Address
		
Telephone Number