Form Boe-400-Fen-Application For Fuel Exemption Number November 2003
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1BOE-400-FEN (FRONT) (11-03)
STATE OF CALIFORNIA
APPLICATION FOR FUEL EXEMPTION NUMBER
BOARD OF EQUALIZATION
Read instructions on reverse before comleting this form.
SECTION I: OWNERSHIP AND BUSINESS INFORMATION
FOR BOARD USE ONLY
1. TYPE OF OWNERSHIP (check one)
TAX
IND
OFFICE
ACCOUNT NUMBER
Sole Owner
Husband and Wife
SJ
Corporation
Limited Liability Company (LLC)
NAICS CODE
BUS. CODE
AREA CODE
85
General Partnership
Unincorporated Business Trust
PROCESSED BY
CERTIFICATE
REPORTING BASIS
Limited Partnership
Limited Liability Partnership (LLP)
ISSUE DATE
X
(mm/dd/yy)
Other
STARTING DATE (mm/dd/yy)
2. NAME OF SOLE OWNER, HUSBAND AND WIFE, CORPORATION, LLP, PARTNERSHIP OR TRUST
3. COUNTRY/STATE OF INCORPORATION OR ORGANIZATION
4. NAME OF PURCHASING CARRIER
5. DATE PURCHASES WILL BEGIN (mm/dd/yy)
6. NATURE OF BUSINESS
Air Common Carrier
Water Common Carrier
7. BUSINESS ADDRESS (street, city, state/country, zip code)
8. MAILING ADDRESS (street, city, state/country, zip code, if different from business address)
SECTION II: AGENT INFORMATION
9. NAME OF AGENT IF APPLICABLE (submit copy of authorization with this application)
10. AGENT’S BUSINESS PHONE NUMBER
(
)
11. AGENT’S BUSINESS ADDRESS (street, city, state/country, zip code)
12. AGENT’S MAILING ADDRESS (street, city, state/country, zip code, if different from business address)
FILING INSTRUCTIONS
You will be required to file returns when (1) you are notified by the Board of Equalization to do so, or (2) when you incur a sales or use tax
liability based on consumption of fuel erroneously claimed as exempt from sales or use tax at the time of purchase.
CERTIFICATION
I am duly authorized to sign this application and certify the statements made are correct to the best of my knowledge and belief.
I am duly authorized to sign this application and certify the statements made are correct to the best of my knowledge and belief.
NAME (type or print)
SIGNATURE
✍
DATE (mm/dd/yy)
BUSINESS PHONE
TITLE
(
)
FOR BOARD USE ONLY
FURNISHED TO TAXPAYER
BOE-519
Reg. 1621
Reg. 1667
Reg. 1702.5 Other
REMARKS
CLEAR
PRINT
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Parent category: Financial