Form Boe-555-Lj - Eft Authorization Agreement For Local Jurisdictions
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1BOE-555-LJ (FRONT) REV. 1(10-02)
STATE OF CALIFORNIA
EFT AUTHORIZATION AGREEMENT FOR LOCAL JURISDICTIONS
BOARD OF EQUALIZATION
Please type or print clearly in ink.
See reverse for complete instructions.
SELECT ACTION REQUESTED
SELECT TAX PROGRAM
New EFT Account
1% Local Tax
Change EFT Bank Account – (see instructions)
¼% (County) Transportation Fund
Cancel EFT
Add-on (Special District) Tax
SECTION I
NAME OF LOCAL JURISDICTION OR SPECIAL DISTRICT (payee)
TAX AREA CODE
CONTACT PERSON (name and title)
CONTACT PHONE NUMBER
MAILING ADDRESS
CITY, STATE, ZIP
SECTION II
The State Controller’s Office, on behalf of the State Board of Equalization, is hereby authorized to make direct deposit (EFT)
of any amounts distributed pursuant to the Bradley-Burns Uniform Local Sales and Use Tax Law or the Transactions and Use
Tax Law less any mandatory withholding or deductions therefrom to the designated bank account identified below. If the
designated EFT account is a checking account, a voided check or copy must be attached to the completed authoriza-
tion agreement. If the account is a savings or other deposit-only account, an account confirmation from the bank must
be attached. The voided check or confirmation will be used to verify the bank account and transit routing numbers.
BANK NAME
BANK ACCOUNT NUMBER (not to exceed 17 digits)
TRANSIT ROUTING NUMBER
TYPE OF ACCOUNT
CHECKING
SAVINGS
IMPORTANT
Payee agrees that in the event that the payee owes a debt determined either by court order, or otherwise by operation of
law, and for which the Board has been notified according to law, to make repayments by deductions from Local Sales and
Use Tax transmittals, the payee will be removed from the EFT program until the debt is extinguished.
SIGNATURE
TITLE
DATE
Return this form to:
(Hard Copy with Original Signature Required)
Board of Equalization
Local Revenue Allocation Section
P.O. Box 942879, MIC:27
Sacramento, CA 94279-0027
FAX 916-324-8117
For EFT assistance call 916-324-1386
This information is confidential and not for public release.
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