Form Boe-501-Dg - Government Entity Diesel Fuel Tax Return
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1
2
3STATE OF CALIFORNIA
BOE-501-DG (S1) REV. 3 (7-07)
BOARD OF EQUALIZATION
GOVERNMENT ENTITY DIESEL FUEL TAX 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
FUEL TAXES DIVISION
PO BOX 942879
SACRAMENTO, CA 94279-6157
READ INSTRUCTIONS
READ INSTRUCTIONS
BEFORE PREPARING
BEFORE PREPARING
REPORT WHOLE
GALLONS ONLY
REPORT OF DIESEL FUEL TRANSACTIONS
1.
Total gallons of undyed diesel fuel purchased
1.
2.
Total gallons of dyed diesel fuel purchased
2.
3.
Total gallons of undyed diesel fuel sold
3.
4.
Total gallons of dyed diesel fuel sold
4.
GOVERNMENT ENTITY TAX RETURN OR CLAIM FOR REFUND
Total gallons of undyed diesel fuel used
5.
5.
6.
Total gallons of dyed diesel fuel used
6.
7.
Total gallons of diesel fuel used (add lines 5 and 6)
7.
8.
Total gallons of diesel fuel used off-highway included in line 7
8.
Taxable diesel fuel used on highway (subtract line 8 from line 7)
9.
9.
10.
Rate of tax per gallon
10.
.18
$
11. Total tax due on diesel fuel used on highway in this state (multiply line 9 by rate on line 10)
11.
$
12.
California diesel fuel tax paid to retail vendor on fuel included in line 5
12.
13.
13. $
Amount of tax due or refund claimed (If line 11 is greater than line 12, enter the difference
as tax due. If line 12 is greater than line 11 enter the difference as refund amount. Enter
amount of refund as a negative.) (Do not claim credit on the next return; a refund will
be processed.)
14.
14. $
Penalty [multiply line 13 by 10% (0.10) if payment made or return filed after the
PENALTY
due date shown above]
INTEREST: One month's interest is due on tax for each month or fraction of a month that payment is
15.
15.
$
INTEREST
delayed after the due date. The adjusted monthly interest rate is
16.
TOTAL AMOUNT DUE AND PAYABLE OR REFUND CLAIMED (Add lines 13, 14, and 15 if tax
16. $
is due. If claiming a refund, enter the amount from line 13 as a negative number.)
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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