Form Boe-129-Eft - Eft Transmission Declaration

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BOE-129-EFT (3-07)
STATE OF CALIFORNIA
EFT TRANSMISSION DECLARATION
BOARD OF EQUALIZATION
INSTRUCTIONS: Please complete the entire form and return it to the Board of Equalization (Board) office
that provided this form to you. Otherwise, you may mail the completed form to your local Board office
listed in the telephone directory under State Government, or as listed on our website at
Upon receipt of the completed form, the Board will review it and you will be notified by mail of the decision.
NAME OF TAXPAYER/FEEPAYER
ACCOUNT NUMBER
REPORTING PERIOD
, state that at approximately
I,
print name
day of
a.m./p.m. on the
time
circle one
date
month and year
I initiated an Electronic Funds Transfer to the State Board of Equalization as follows:
Internet Method
Touch Tone Telephone
Voice Operator
Payment amount:
Debit date selected (if any):
Reference Number Received:
Explanation:
CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
SIGNATURE
TITLE
DATE
PRINTED NAME
TELEPHONE NUMBER
(
)
CLEAR
PRINT

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