Form Boe-101 - Claim For Refund Or Credit

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BOE-101 (FRONT) REV. 4 (5-02)
STATE OF CALFORNIA
CLAIM FOR REFUND OR CREDIT
BOARD OF EQUALIZATION
(Instructions on back)
NAME OF TAXPAYER(S)
TAXPAYER'S ACCOUNT NO.
GENERAL PARTNER (IF APPLICABLE)
TAXPAYER'S SOCIAL SECURITY NUMBER(S)*
Pursuant to
Chapter 7, Article 1, of the California Sales and Use Tax Law and, where applicable, Uniform
Local Sales and Use Tax Ordinances and the Transit District Transactions (Sales) and Use
Tax Ordinances, or
Chapter 6, Article 1, of the California Use Fuel Tax Law, or
Chapter 8, Article 1 and 2, of the Diesel Fuel Tax Law,
the undersigned hereby makes claim for refund or credit of $__________________ , or such other amounts as may be established,
in tax, interest and penalty in connection with:
Return(s) filed for the period ____________________________________ to _________________________________________
Determination(s) dated ___________________________________ and paid _________________________________________
Other (describe fully)
The overpayment described above was caused by
FIRM NAME
SIGNED BY
DATE SIGNED
PRINT NAME OF SIGNATORY
TITLE OR POSITION
Credit interest is available under certain circumstances. If you would like to be considered for credit interest, please check here.
*See form BOE-324-GEN, for the Privacy Act Statement regarding disclosure of the applicable Social Security Number.
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