Form Boe-501-Ps - Supplier Of Motor Vehicle Fuel Tax Return - 2013

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BOE-501-PS (S1) REV. 9 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
BOE USE ONLY
SUPPLIER OF MOTOR VEHICLE FUEL TAX RETURN
AUD
RA-B/A
REG
DUE ON OR BEFORE
FILE
RR-QS
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-6135
READ INSTRUCTIONS
BEFORE PREPARING
As a supplier of motor vehicle fuel in California, you are required to report all imports, exports, blending, and terminal rack
disbursements of motor vehicle fuel in this state.
REPORT WHOLE
GALLONS ONLY
(B)
(A)
(C)
Motor Vehicle Fuel
Motor Vehicle Fuel
Aviation
at Prior Rate
at Current Rate
Gasoline
1. Taxable gallons (enter from Tax Computation Worksheet
1.
section C, line 3, columns A, B, and C)
2. Rates of tax per gallon
2.
$
$
$
3. Subtotal of tax due (multiply line 1 by line 2 for
3.
$
$
$
columns A, B, and C)
4. Total tax due (add columns A, B, and C of line 3)
4. $
5. Penalty (multiply line 4 by 10% (0.10) if payment made or return filed after due date
5. $
shown above. See return instructions if you made a prepayment.)
6. INTEREST:
One month's interest is due on tax for each month or fraction of a month that
6. $
payment is delayed after the due date. The adjusted monthly interest rate is
7. $
7. TOTAL AMOUNT DUE AND PAYABLE (add lines 4, 5, and 6)
CERTIFICATION
I hereby consent to disclose and authorize the Board of Equalization (BOE) to release, as necessary, certain otherwise
confidential transaction information regarding volumes, invoice numbers, bills-of-lading, locations, dates, or method of
delivery of reportable products to any person identified by me in this return as being involved in a reported transaction for the
sole purpose of verifying the accuracy of the reportable product transaction information concerning my transactions with such
person as reported in this return.
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.
EMAIL ADDRESS
SIGNATURE
PRINT NAME AND TITLE
TELEPHONE
DATE
(
)
Make check or money order payable to the State Controller.
Always write your account number on your check or money order. Make a copy of this document and the accompanying schedules for your records.

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