Form Boe-28 - Certification As To Use Of Equipment

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BOE-28 REV. 1 (10-07)
STATE OF CALIFORNIA
CERTIFICATION AS TO USE OF EQUIPMENT
BOARD OF EQUALIZATION
This vehicle has not been operated or it has been in the possession of:
NAME
TELEPHONE NUMBER
(
)
ADDRESS (street, city, state, zip code)
For the period(s) of:
FROM
TO
FROM
TO
And that the equipment (check whichever applies):
HAS BEEN STORED
HAS BEEN USED ON PRIVATE PROPERTY EXCLUSIVELY
HAS BEEN USED AND ALL USE FUEL TAXES HAVE BEEN PAID BY (list below)
NAME
USE FUEL TAX PERMIT NUMBER
Further, that (please check one):
NO TAX CLEARANCE CERTIFICATE COVERING THIS EQUIPMENT HAS PREVIOUSLY BEEN RECEIVED
TAX CLEARANCE CERTIFICATES PREVIOUSLY ISSUED ARE (check one)
ATTACHED
UNAVAILABLE (If unavailable, please explain usage or disposition below.)
EXPLANATION
I hereby certify that the statements above are correct to the best of my knowledge and belief.
SIGNATURE
TITLE
ADDRESS (street, city, state, zip code)
DATE
Mail completed form to Motor Carrier Section, MIC:65, State Board of Equalization, PO Box 942879,
Sacramento, CA 94279-0065. If you have any questions regarding specific vehicle transfers, please telephone
the Motor Carrier Section at 916-322-9669.
CLEAR
PRINT

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