Form Boe-501-Db - Exempt Bus Operator Diesel Fuel Tax Return Page 4

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BOE-501-DB (S3) REV. 7 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
RECEIPT SCHEDULE 2A
(If additional space is needed, please photocopy the schedule before making entries.)
Page
of
(a) COMPANY NAME
(b) ACCOUNT NUMBER
(c) SCHEDULE CODE
(d) PRODUCT CODE
(e) MONTH/YEAR
2A
(4)
(5)
(1)
(2)
(7)
(8)
(9)
(11)
(3)
(6)
(10)
POINT OF
ACQUIRED FROM
DOCUMENT
CARRIER
CARRIER
MODE
SELLER'S
DOCUMENT
NET
GROSS
BILLED
FEIN
(Seller's Name)
DATE
NUMBER
GALLONS
GALLONS
FEIN
GALLONS
NAME
ORIGIN
DESTINATION
(TCN or
(TCN or
State/Province)
State/Province)
TOTAL
CLEAR
PRINT

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