Form Boe-501-Ec - Consumer'S Electrical Energy Surcharge Return
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2BOE-501-EC (FRONT) REV. 5 (7-07)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
CONSUMER'S ELECTRICAL ENERGY SURCHARGE RETURN
BOARD USE ONLY
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
EXCISE TAXES DIVISION
P O BOX 942879
SACRAMENTO CA 94279-6083
READ INSTRUCTIONS
BEFORE PREPARING
SOURCE FROM WHOM ELECTRICAL ENERGY WAS PURCHASED WITHOUT SURCHARGE
NAME
ADDRESS
1. Energy purchased without surcharge and used in California (in kilowatt-hours)
1.
2.
2.
Rate of surcharge
3.
Amount of surcharge (multiply line 1 by rate of surcharge)
3.
4. Penalty [multiply line 3 by 10% (0.10) if payment is made after due date shown above]
4.
PENALTY
5.
INTEREST: One month's interest is due on the surcharge for each month or fraction of a month that payment
5.
INTEREST
is delayed after the due date. The adjusted monthly interest rate is
6.
TOTAL AMOUNT DUE AND PAYABLE (add lines 3, 4, and 5)
$
6.
IF PAID BY CREDIT CARD, CHECK HERE (Mandatory EFT accounts MUST pay by EFT). [
]
I hereby certify that this return, including any 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
TELEPHONE NUMBER
DATE
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 for your records.
CLEAR
PRINT
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