Form Boe-512-Ad - Request For Additional Annual Flat Rate Decals Page 2

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BOE-512-AD (S2F) REV. 4 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
SUPPLEMENTAL VEHICLE LIST
Account Number
Name
Before preparing read instructions on reverse and follow fee schedule example.
A
B
C
D
E
F
BOE USE ONLY
MAKE
YEAR
LICENSE NUMBER
UNLADEN
TYPE OF FUEL
FEE
(Decal Number)
WEIGHT
USED
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
TOTAL FEES ENCLOSED
CLEAR PRINT

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