City of Cathedral City
Department of Finance
Cathedral City CANNABIS AND MARIJUANA DISPENSARY TAX REMITTANCE FORM (For collectives operating with a valid city-issued permit) Business Name: CC Industry LLC FEIN OR SSN: 86-2185874
Address: 69375 Ramon Road Cathedral City CA 92234
Phone Number: (310)936-6076 G/L Number: 100-9996-6204-0001 Owner Name: Rommy Shy Email: [email protected]/[email protected]
MONTH OF DUE DATE DELINQUENT IF NOT RECEIVED BY
August
The information that you provide in this remittance form will be maintained as confidential under Rev. and Tax Code § 7284.6.
1. Gross receipts for the period: $409.50
2. Add increasing adjustments - Prior
months (explain)
3. Adjusted Gross Receipts (add lines
1 and 2)
4. Decreasing adjustments - Prior
months (explain)
5. Total deductions from line 4
6. Taxable receipts (line 3 less line 5)
7. Amount of tax due (10% of line 6)
8. Penalty of 25% on tax due if not
25%
received in our office by the date
shown above. Penalty
9. Interest of ½% per month on any
unpaid tax and penalty not received 1/2%
in our office by the original due date. Interest
10. Tax adjustment - Per correction
notice from City if applicable
11. Total amount due and payable
(lines 7 through 10)
Remit To: City of Cathedral City
Attn: Finance Depart - Cannabis & Marijuana Tax
68-700 Avenida Lalo Guerrero
Cathedral City, CA 92234
Please note, all taxes collected during any given month must be received by the City no later than the end of the following month. Penalties and interest will be imposed on delinquent payments. See Sec. 3.48.03.
Please prepare a separate remittance form for each tax period; do not combine tax period.
Signed Title COO Date 9/4/2025
Executed at Cathedral City or