Form Boe-400-Er - Application For Electronic Waste Recycling Fee Account - California

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BOE-400-ER (FRONT) REV. 2 (2-05)
STATE OF CALIFORNIA
APPLICATION FOR ELECTRONIC WASTE RECYCLING FEE ACCOUNT
BOARD OF EQUALIZATION
SECTION I: SALES OR USE TAX ACCOUNT INFORMATION
FOR BOARD USE ONLY
1. PLEASE ENTER YOUR SALES AND/OR USE TAX ACCOUNT NUMBER(S) (if registered with the Board of Equalization)
ER
ER
ELECTRONIC WASTE RECYCLING FEE
General Information
Beginning January 1, 2005, the retail sale of covered electronic devices (CED) is subject to a new electronic waste recycling
fee. If you are a retailer who sells devices covered by the fee, you must register with the Board of Equalization (Board),
collect the fee from your customers, file quarterly fee returns, and pay the collected fees to the Board.
For more information on the fee, see our website:
Registration Requirements
To register for the fee, please complete, sign, date, and return this application in person or by mail. Be sure to complete all
three sections. We cannot process your application if it is incomplete or if you do not sign in Section IV. Be sure to record
your seller's permit number or use tax account number in Section I above. Your registration may be delayed without this
information.
Filing Requirements
Feepayers will be required to file a return and pay the fees on a quarterly basis. Your return and payment will be due on or
before the last day of the month following the end of the calendar quarter. You must file a return every quarter even if you
do not collect any fees. Depending on your fee collections, we may require you to file returns and pay the fee on a monthly
or yearly basis instead of quarterly.
SECTION II: OWNERSHIP INFORMATION
1. PLEASE CHECK TYPE OF OWNERSHIP
Sole Owner
Husband & Wife Co-Ownership
Domestic Partnership
Limited Partnership
General Partnership
Corporation
Limited Liability Company (LLC)
Other
2. OWNER NAME(S) (include all individual owners, general partners or full corporate, limited liability company (LLC), or organization name) (attach additional page if necessary)
SECTION III: BUSINESS INFORMATION
1. BUSINESS OR TRADE NAME (DBA if any)
2. BUSINESS TELEPHONE NUMBER
3. BUSINESS ELECTRONIC MAIL ADDRESS
4. BUSINESS ADDRESS (do not list PO Box or mailing service)
CITY
ZIP CODE
STATE
5. MAILING ADDRESS (if different from No. 4 above)
CITY
ZIP CODE
STATE
6. ADDRESS WHERE BUSINESS RECORDS WILL BE MAINTAINED
7. TYPES OF PRODUCTS SOLD
Laptops
Computers/Monitors
Televisions
Other CEDs
(check website for other types)
SECTION IV: CERTIFICATION
I certify and declare, under penalty of perjury, that the information contained herein is correct to
the best of my knowledge and that I am authorized to sign and certify this application.
NAME (type or print)
DATE
SIGNATURE
TITLE
Return Application to: Board of Equalization, Electronic Waste Recycling Fee Section
PO Box 942879, Sacramento, CA 94279-0088
FOR BOARD OF EQUALIZATION TAX ASSISTANCE
INFORMATION CENTER
TAXPAYERS'
ELECTRONIC WASTE RECYCLING
800-400-7115
RIGHTS ADVOCATE
FEE SECTION
TTY/TDD 800-735-2929
916-341-6906
888-324-2798
CLEAR
PRINT

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