Form Boe-501-Dd - Supplier Of Diesel Fuel Tax Return - State Of California

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BOE-501-DD (S1) REV. 4 (4-03)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
SUPPLIER OF DIESEL FUEL TAX RETURN
BOARD USE ONLY
RA-B/A
AUD
REG
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
REF
[
]
YOUR ACCOUNT NO.
FOID
EFF
BOARD OF EQUALIZATION
FUEL TAXES DIVISION
P O BOX 942879
SACRAMENTO CA 94279-6161
READ INSTRUCTIONS
BEFORE PREPARING
As a supplier of diesel fuel in California, you are required to report all imports, exports, blending, and terminal rack
removals of diesel fuel in this state. You are also required to report all imports, exports, and sales of jet fuel or kerosene.
REPORT WHOLE
GALLONS ONLY
1. Gallons for which tax applies or refund due (enter from Tax Computation Worksheet
1.
section C, line 3)
.18
2. Rate of tax per gallon
2.
$
3. Amount of tax due or refund claimed (multiply line 1 by line 2. Enter amount of refund
3.
$
as a negative number.)
4. Penalty (multiply line 3 by 10% (0.10) if payment made after due date shown above)
4.
$
5. INTEREST:
One month's interest is due on tax for each month or fraction of a month that
5.
$
payment is delayed after the due date. The adjusted monthly interest rate is
TOTAL AMOUNT DUE AND PAYABLE OR REFUND CLAIMED (add lines 3, 4, and 5
6.
6.
$
if tax is due. If claiming a refund, enter the amount from line 3 as a negative number.)
CERTIFICATION
I hereby consent to disclose and authorize the Board to release, as necessary, certain otherwise confidential transaction
information regarding volumes, invoice numbers, bills-of-lading, locations, dates, or method of delivery of reportable
products to any person identified by me in this return as being involved in a reported transaction for the sole purpose of
verifying the accuracy of the reportable product transaction information concerning my transactions with such person as
reported in this return.
I hereby certify that this return, including all accompanying schedules and statements, has been examined by me and to the
best of my knowledge and belief is a true, correct and complete return.
YOUR SIGNATURE AND TITLE
DATE
TELEPHONE NUMBER
MAKE CHECK OR MONEY ORDER PAYABLE TO STATE BOARD OF EQUALIZATION.
Always write your account number on your check or money order.
Make a copy of this document and the accompanying schedules for your records.

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