Form Boe-400-Fen - Application For Fuel Exemption Number
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2BOE-400-FEN (FRONT) REV. 1 (9-10)
STATE OF CALIFORNIA
APPLICATION FOR FUEL EXEMPTION NUMBER
BOARD OF EQUALIZATION
Read instructions on reverse before completing this form.
SECTION I: OWNERSHIP AND BUSINESS INFORMATION
FOR BOE USE ONLY
1.
TYPE OF OWNERSHIP (check one)
TAX
IND
OFFICE
ACCOUNT NUMBER
SJ
Sole Owner
Married Co-ownership
Corporation
Limited Liability Company (LLC)
NAICS CODE
BUS. CODE
AREA CODE
85
General Partnership
Unincorporated Business Trust
PROCESSED BY
CERTIFICATE
REPORTING BASIS
Limited Partnership
Limited Liability Partnership (LLP)
ISSUE DATE
X
(mm/dd/yy)
Registered Domestic Partnership
STARTING DATE (mm/dd/yy)
Other___________________________________________________
2. NAME OF SOLE OWNER, MARRIED CO-OWNERSHIP, REGISTERED DOMESTIC PARTNERSHIP, CORPORATION, LLP, PARTNERSHIP OR TRUST
3. COUNTRY/STATE OF INCORPORATION OR ORGANIZATION
4. NAME OF PURCHASING CARRIER
5. DATE PURCHASES WILL BEGIN (mm/dd/yy)
6. NATURE OF BUSINESS
Air Common Carrier
Water Common Carrier
7. BUSINESS ADDRESS (street, city, state/country, zip code)
8. EMAIL ADDRESS
9. MAILING ADDRESS (street, city, state/country, zip code, if different from business address)
SECTION II: AGENT INFORMATION
10. NAME OF AGENT IF APPLICABLE (submit copy of authorization with this application)
11. AGENT’S BUSINESS PHONE NUMBER
12. AGENT’S BUSINESS ADDRESS (street, city, state/country, zip code)
13. AGENT’S EMAIL ADDRESS
14. AGENT’S MAILING ADDRESS (street, city, state/country, zip code, if different from business address)
FILING INSTRUCTIONS
You will be required to file returns when (1) you are notified by the Board of Equalization (BOE) to do so, or (2) when you incur a sales or use
tax liability based on consumption of fuel erroneously claimed as exempt from sales or use tax at the time of purchase.
CERTIFICATION
I am duly authorized to sign this application and certify the statements made are correct to the best of my knowledge and belief.
NAME (type or print)
SIGNATURE
BUSINESS PHONE
TITLE
DATE (mm/dd/yy)
FOR BOE USE ONLY
FURNISHED TO TAXPAYER
BOE-519
Reg. 1621
Reg. 1667
Reg. 1702.5 Other _______________________________________________________
REMARKS
CLEAR
PRINT
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Parent category: Business