Form BOE-232 Fillable Annual Certification Regarding Solicitation Activities
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

including but not limited to distributing flyers (address of authorized representative) (address of organization) (address of person signing) (address of persons authorized representative when applicable) (area code) (CLEAR) CLEAR (Date) (organizations name) (organizations website) (out of state retailer) (out of state retailer's name) (persons name) (previous year) (PRINT) PRINT (printed name of authorized representative) (printed name of person signing) (telephone number) (title) (to be completed by organizations) (to be completed by persons operating in California) 1 The retailer s agreement prohibits persons operating under the agreement from engaging in any solicitation 1) the agreement provides that the organization will maintain information on its website alerting its members to the 2 The person or persons operating under the agreement in California certify annually under penalty of 3 The retailer accepts the certification or certifications in good faith and the retailer does not know or have a club or non profit group is not subject to the affiliate nexus provision if in addition to the above requirements A person may complete the Annual Certification of No Solicitation section on the next page or any document that A retailer engaged in business in this state as defined in Revenue and Taxation Code (RTC) section 6203 is activities in California that refer potential customers to the retailer including but not limited to distributing addition Regulation 1684 provides that a retailer can demonstrate that an agreement is not an agreement subject to ADDITIONAL STATEMENT FROM ORGANIZATION ADDRESS OF AUTHORIZED REPRESENTATIVE (street city state zip code) ADDRESS OF ORGANIZATION (street city state zip code) ADDRESS OF PERSON S AUTHORIZED REPRESENTATIVE WHEN APPLICABLE (street city state zip code) ADDRESS OF PERSON SIGNING (street city state zip code) AFFILIATE NEXUS INFORMATION agreement or agreements under which a person or persons in this state for a commission or other consideration An organization may complete the Additional Statement from Organization section on the next page or any document and the person named below has not engaged in prohibited solicitation activities in California that refers potential ANNUAL CERTIFICATION BOARD OF EQUALIZATION ANNUAL CERTIFICATION OF NO SOLICITATION based link or an Internet website or otherwise provided that the retailer s sales exceed two specific sales BOE 232 BACK (9 12) BOE 232 FRONT (9 12) STATE OF CALIFORNIA certification from the organization under penalty of perjury that includes a statement certifying that its website certification requirements of Regulation 1684 for a minimum of eight years coupons newsletters and other printed promotional materials or electronic equivalents verbal soliciting (for example customers to at any time during the previous year described above described above The BOE recommends you retain this form or any other document that satisfies the annual directly or indirectly refers potential purchasers of tangible personal property to the retailer whether by an Internet does not apply if a retailer can demonstrate that all of the persons with whom the retailer has agreements described engaged in any prohibited solicitation activities in California at any time during the previous year engaged in business in this state and is required to register to collect California use tax if the retailer enters into an flyers coupons newsletters and other printed promotional materials or electronic equivalents verbal I HEREBY CERTIFY UNDER PENALTY OF PERJURY: in person referrals) initiating telephone calls and sending emails in the affiliate nexus provision did not directly or indirectly solicit potential customers for the retailer in California In includes information directed at its members alerting them to the prohibition against the solicitation activities Instructions for Annual Certification is prohibited from engaging in any solicitation activities in California that refers potential customers to ORGANIZATION S NAME ORGANIZATION S WEBSITE OUT 0F STATE RETAILER S NAME OUT 0F STATE RETAILER S NAME XX XX XX TO XX XX XX OUT OF STATE RETAILER perjury that they have not engaged in any prohibited solicitation activities in California at any time during PERSON S NAME PRINTED NAME OF AUTHORIZED REPRESENTATIVE PRINTED NAME OF PERSON SIGNING printed promotional materials or electronic equivalents verbal soliciting (for example in person referrals) initiating prohibition against each of the solicitation activities described above and 2) the retailer obtains an annual property to California customers reason to know that the certification or certifications are false or fraudulent REGARDING SOLICITATION ACTIVITIES Regulation 1684 further provides that a retailer can demonstrate that an agreement with an organization such as required to register with the Board of Equalization (BOE) to collect and remit use tax on sales of tangible personal RTC section 6203 subdivision (c)(5) includes an affiliate nexus provision Under the provision a retailer is Sales and Use Tax Regulation 1684 Collection of Use Tax by Retailers explains that the affiliate nexus provision satisfies the requirements of Regulation 1684 to annually certify under penalty of perjury that the person has not SIGNATURE OF ORGANIZATION S AUTHORIZED REPRESENTATIVE DATE SIGNATURE OF PERSON OR PERSON S AUTHORIZED REPRESENTATIVE DATE soliciting (for example in person referrals) initiating telephone calls and sending emails; telephone calls and sending emails TELEPHONE NUMBER that satisfies the requirements of Regulation 1684 to annually certify under penalty of perjury that its website That the person named below is operating under an agreement with That the website of the organization named below includes information that alerts its members that anyone operating the affiliate nexus provision if: the previous year; and The prohibited solicitation activities include but are not limited to distributing flyers coupons newsletters and other thresholds TITLE under the organization s agreement with