Form Boe-501-Tf - California Tire Fee Return
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1
2BOE-501-TF (FRONT) REV. 12 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
CALIFORNIA TIRE FEE RETURN
BOE USE ONLY
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
YOUR ACCOUNT NO.
[
FOID
]
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
P O BOX 942879
SACRAMENTO CA 94279-6087
READ INSTRUCTIONS
BEFORE PREPARING
GENERAL INFORMATION
tate Board of Equalization (BOE) is responsible for collecting fees under the California Tire Recycling Act.
The S
FILING REQUIREMENTS
ach retail seller of new tires must file a return on or before the date shown above. The return must be
E
accompanied by a remittance payable to the BOE for the amount of any fee due for that period, plus any
applicable penalty and interest. This return must be filed even if no fees are due.
1. Total number of new tires sold at retail and new tires self consumed
1.
2. Rate of fee per tire
$
2.
3. Total amount of fees (multiply line 1 by line 2)
$
3.
.00
4. Less seller reimbursement fee. Multiply line 3 by reimbursement rate of
4.
$
.00
5. Total amount of fees due (subtract line 4 from line 3)
5.
$
.00
6. Penalty [multiply line 5 by 10% (0.10) if payment is made after due date shown above]
$
6.
.00
PENALTY
7.
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that
$
7.
.00
INTEREST
payment is delayed after the due date. The adjusted monthly interest rate is
8. TOTAL AMOUNT DUE AND PAYABLE (add lines 5, 6, and 7)
8.
$
.00
EMAIL ADDRESS
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.
TELEPHONE
SIGNATURE
PRINT NAME AND TITLE
DATE
(
)
Make check or money order payable to State Board of Equalization.
Always write your account number on your check or money order. Make a copy of this document for your records.
CLEAR
PRINT
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