S
B
TATE
OARD
O
E
Your Consumer Use Tax Account May Qualify
F
QUALIZATION
for an Installment Payment Agreement
450 N Street
Sacramento
California 95814
You may be eligible to pay your Consumer Use Tax liability in smaller and more manageable
payments by applying for an installment payment agreement (agreement). If you qualify, you
may pay your liability in weekly, bi-weekly (every other week), monthly, or twice monthly
installments. The amount of your installment payments will depend on the amount you owe
and your ability to pay. You may need to complete BOE-403-E, Individual Financial Statement,
and provide other documents. These documents will be reviewed to determine if you qualify
for an agreement.
BOARD MEMBERS
Since interest and penalties accrue on any unpaid tax amount until paid in full, an agreement
Names updated 2012)
(
may cost you more than if you pay the entire balance by borrowing the money from a third
party. Additionally, a state tax lien may be recorded even if you enter into an agreement.
BETTY T. YEE
First District
San Francisco
If you wish to propose an agreement, please complete the section below. Send this form, your
SEN. GEORGE RUNNER (R
.)
et
Second District
completed tax return (if not previously filed), and a payment in the amount of your proposed
Lancaster
installment payment in the enclosed return envelope. Continue to send your proposed pay
MICHELLE STEEL
Third District
ments until we notify you otherwise. Please write your account number on your check or
Orange County
money order.
JEROME E. HORTON
Fourth District
Los Angeles
If your proposal is accepted, you will be required to make your installment payments using
JOHN CHIANG
Auto Pay. With Auto Pay, we will automatically debit your checking or savings account for
State Controller
payments required by your agreement. An Auto Pay authorization form and details regarding
CYNTHIA BRIDGES
this program will be provided with your agreement.
Executive Director
Print name as shown on tax return
Consumer use tax aCCount
ProPosed Payment amount
(check one)
$
Monthly
Twice Monthly
Weekly
Bi-Weekly
signature
date
-
daytime Phone number
driver LiCense number
(
)
soCiaL seCurity number (see BOE-324-GEN for SSN disclosure information)
For more information, contact the Centralized Collection Section at 916-445-3670 or visit our
website at
BOE-126 REV. 4 (12-08)
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