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Form BOE-514-DI Fillable Acknowledgement of Licensee Responsibilities Under the California Interstate User Diesel Fuel Tax
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)All distance traveled All fuel purchases Failure to file the Interstate User Diesel Fuel Tax Return to make records available and/or to provide adequate Failure to pay assessments may result in impoundment of your QMV The BOE may sell the impounded QMV to If you do not file your Interstate User Diesel Fuel Tax Return timely you will be subject to penalty and interest If you do not possess a copy of your California Interstate User Diesel Fuel Tax License or a valid California Fuel Trip Other information as required by the Board of Equalization (BOE) You must carry a copy of your California Interstate User Diesel Fuel Tax License in each of your QMVs You must complete and file the Interstate User Diesel Fuel Tax Return on or before the due date for each reporting You must maintain these records for a period of four years from the due date of your Interstate User Diesel Fuel Tax You must pay amounts due on or before the due date of the return or billing You must prepare and maintain operational records for each qualified motor vehicle (QMV) to support: You must report your travel and fuel purchases for each QMV on the Interstate User Diesel Fuel Tax Return (ACCOUNT NUMBER DI MT 57 ) (CITY) (DATE) (NAME (please print)) (STATE) (STREET ADDRESS) (TITLE) (ZIP CODE) *This document must be signed by a corporate officer owner partner or an authorized company employee not a service agent 0065 by calling 916 322 9669 or by calling our Taxpayer Information Section at 800 400 7115 (TTY:711) 4 00 miles per gallon and 30 000 miles per QMV per calendar quarter to calculate the tax liability plus applicable ACCOUNT NUMBERDI MT 57 ACKNOWLEDGEMENT OF LICENSEE BOE 514 DI (12 10) carries with it many responsibilities collect amounts due DECLARATION Detailed information on each of the above requirements can be found at our website at www boe ca gov Diesel Fuel Tax due Simply providing information to your service agent does not mean your tax returns have been filed with the BOE If you do not fulfill your responsibilities under your California Interstate User Diesel Fuel Tax License you will be subject INTERSTATE USER DIESEL FUEL TAX Law Printed copies can be obtained by writing to the Motor Carrier Office P O Box 942879 Sacramento CA 94279 NAME (please print) of $500 or 25% of the tax assessed whichever is greater The tax and penalty assessments must be paid before penalties and interest In addition no credit for tax paid fuel will be allowed period Permit when entering California you may be assessed a penalty from $100 to $500 or if tax is assessed a penalty Please Note: You are responsible for all of the above items If you use a service agent and that person does not maintain records for audit may result in an assessment based on an estimation of the fleet's true liability using figures of RESPONSIBILITIES UNDER THE CALIFORNIA Return or the date the return was filed whichever is later SIGNATURE STATE STATE OF CALIFORNIABOARD OF EQUALIZATION STREET ADDRESS The undersigned* has read this document and acknowledges the responsibilities of holding a license under the California TITLE to one or more actions by the BOE: You have applied for or have been granted a license under the California Interstate User Diesel Fuel Tax The license your QMV will be allowed to leave the inspection site your records as indicated above or does not file your returns timely you are responsible for any tax penalty and interest ZIP CODE