Form Boe-501-Tf - California Tire Recycling Fee Return
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1
2BOE-501-TF (FRONT) REV. 9 (7-07)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
CALIFORNIA TIRE FEE 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
ENVIRONMENTAL FEES DIVISION
P O BOX 942879
SACRAMENTO CA 94279-6087
READ INSTRUCTIONS
BEFORE PREPARING
GENERAL INFORMATION
The S
tate Board of Equalization (Board) is responsible for collecting fees under the California Tire Recycling Act.
FILING REQUIREMENTS
E
ach retail seller of new tires must file a return on or before the date shown above. The return must be
accompanied by a remittance payable to the Board for the amount of any fee due for that period, plus any
applicable penalty and interest. This return must be filed even though no fees may be due.
Total number of new tires sold at retail
1.
1.
Rate of fee per tire
$
2.
2.
Total amount of fees (multiply line 1 by line 2)
$
3.
3.
.00
4.
Less seller reimbursement fee. Multiply line 3 by reimbursement rate of
4.
$
.00
Total amount of fees due (subtract line 4 from line 3)
5.
$
.00
5.
Penalty [multiply line 5 by 10% (0.10) if payment is made after due date shown above]
$
6.
6.
.00
PENALTY
7.
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that
$
7.
.00
INTEREST
payment is delayed after the due date. The adjusted monthly interest rate is
8.
TOTAL AMOUNT DUE AND PAYABLE (add lines 5, 6, and 7)
8.
$
.00
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
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 for your records.
CLEAR
PRINT
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