Form Boe-770-Dz - Claim For Refund On Nontaxable Sales And Exports Of Diesel Fuel Page 3

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BOE-770-DZ (S2F) REV. 5 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
REFUND COMPUTATION WORKSHEET
Use this worksheet to help you complete your claim and calculate the refund due.
Do not send this worksheet with your claim.
(A)
(B)
SECTION A. TAX-PAID CREDITS
FROM
DIESEL FUEL AT
DIESEL FUEL
(Total Gallons)
SCHEDULE
CURRENT RATE
AT PRIOR RATE
1. Tax-paid fuel exported
13A
(enter totals from column 11 on Schedule 13A)
2. Tax-paid fuel sold to the United States Government
13C
(enter totals from column 11 on Schedule 13C)
3. Tax-paid fuel sold to train operators
13G
(enter totals from column 11 on Schedule 13G)
4. Tax-paid fuel used in an exempt manner not reportable on another
13J
credit schedule (enter totals from column 11 on Schedule 13J)
5. TOTAL TAX-PAID GALLONS CLAIMED FOR REFUND (add
lines 1 through 4 for each column) Enter this amount in columns
A and B on line 1 on the front of the claim.
Note: Any schedules required in support of this claim (Schedules 1A, 2A, 12A through 12C, 13A, 13C, 13G. and 13J) must be
completed and submitted with the claim. You must complete Schedules 1A and 2A, as applicable to your purchases, in
support of your claim. If you are claiming a refund and the prior tax rate, you must have reported your below-the-rack
activities on Schedules 12A, 12B, and 12C for all previous reporting` periods from the period prior to the tax rate change
forward through the period on which you are making the claim. For example, to claim a credit transaction claimed at the prior
tax rate in the September 2011 period, you would need to report on these schedules for the June 2011 period and all
subsequent periods. You must also report these schedule activities for this reporting period.
BOE-810-FTE, Instructions for Preparing Motor Fuel Schedules, is available on our website at
and provides detailed instructions on the reporting requirements for these schedules.
CLEAR
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