Form Boe-501-Er - Electronic Waste Recycling Fee Return

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STATE OF CALIFORNIA
BOE-501-ER (FRONT) REV. 10 (3-13)
BOARD OF EQUALIZATION
ELECTRONIC WASTE RECYCLING 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
PO BOX 942879
SACRAMENTO CA 94279-7076
READ INSTRUCTIONS
BEFORE PREPARING
This return includes fees paid to you (vendor) by a retailer pursuant to a lease agreement. (See instructions on reverse.)
COVERED ELECTRONIC DEVICES (CEDs) SOLD OR LEASED
1. Total number of new or refurbished CEDs sold or leased this period
1.
2.
2. Self-consumed new or refurbished CEDs (see instructions on reverse)
3. Total number of items (add lines 1 and 2)
3.
CEDs Excluded from the Fee (enter below, on lines 4, 5, and 6, the number of items included in line 3 that are not subject to the fee)
4.
4. Items sold in interstate or foreign commerce
5.
5. Items sold to other retailers for the purposes of resale
6.
6. Other (see instructions on reverse)
7.
7. Total number of items excluded from the fee (add lines 4, 5, and 6)
8.
8. Total number of items subject to the fee (subtract line 7 from line 3)
GROSS FEES DUE (enter number of items from line 8 by category in column A; multiply
A
B
C
A x B, enter the total in column C)
SUBTOTAL
NUMBER
FEE AMOUNT
9.
$
9. Enter number of CEDs more than 4 inches, less than 15 inches
.00
x
10.
x
$
.00
10. Enter number of CEDs 15 inches, less than 35 inches
11.
x
$
.00
11. Enter number of CEDs 35 inches or more
12. Total (enter total for lines 9C, 10C, and 11C)
$
.00
12.
Returned Merchandise (enter number of CEDs in column A. Multiply A x B; enter total in
A
B
C
NUMBER
FEE AMOUNT
SUBTOTAL
column C) (see instructions on reverse)
13. Enter number of CEDs more than 4 inches, less than 15 inches
$
.00
13.
x
14. Enter number of CEDs 15 inches, less than 35 inches
14.
$
.00
x
15. Enter number of CEDs 35 inches or more
$
.00
15.
x
16. Total Returned Merchandise Credit (enter total for lines 13C, 14C, and 15C)
16.
$
.00
Fee Adjustments
17. Total Fee Credit Adjustment (see instructions on reverse)
$
.00
17.
18. Fees net of returned merchandise and credit adjustment (subtract amounts on lines 16 and 17 from the amount
18.
$
.00
on line 12)
19. Calculate Fee Collection Reimbursement. Multiply amount on line 18 by
19.
$
.00
Amount Due and Payable
20. Total amount of fees due (subtract line 19 from line 18)
20.
.00
$
21. Penalty (multiply line 20 by 10% (0.10) if payment is made after due date shown above)
21.
.00
$
PENALTY
22.
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that
22.
$
.00
INTEREST
payment is delayed after the due date. The adjusted monthly interest rate is
23. TOTAL AMOUNT DUE AND PAYABLE (add lines 20, 21, and 22)
23.
$
.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.
SIGNATURE
PRINT NAME AND TITLE
TELEPHONE
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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