Form Boe-101 - Claim For Refund Or Credit

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BOE-101 (FRONT) REV. 7 (11-09)
STATE OF CALIFORNIA
CLAIM FOR REFUND OR CREDIT
BOARD OF EQUALIZATION
(Instructions on back)
NAME OF TAXPAYER(S) OR FEEPAYER(S)
TAXPAYER’S OR FEEPAYER’S ACCOUNT NO.
GENERAL PARTNER (if applicable)
TAXPAYER’S OR FEEPAYER’S SOCIAL SECURITY NUMBER(S)* OR FEDERAL EMPLOYER IDENTIFICATION NUMBER
According 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,
Other
(please specify the applicable tax law or fee program)
the undersigned hereby makes claim for refund or credit of $
(may be left blank), 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
Supporting Documentation:
is attached
will be provided upon request
BUSINESS NAME
SIGNED BY
DATE SIGNED
PRINT NAME OF SIGNATORY
CONTACT PERSON (if other than signatory)
TITLE OR POSITION
TELEPHONE NUMBER
TITLE OR POSITION OF CONTACT PERSON
TELEPHONE NUMBER
(
)
(
)
.
Credit interest is available under certain circumstances. If you would like to be considered for credit interest, please check here
*See BOE-324-GEN, Privacy Notice, regarding disclosure of the applicable social security number.
FOR BOE USE ONLY
Case ID No.
CLEAR
PRINT

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