Form BOE-401-EZ Fillable Short Form - Sales and Use Tax Return
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

00 00 (14 Tax prepayments; first prepayment; please round cents to the nearest whole dollar) (14 Tax prepayments; second prepayment; please round cents to the nearest whole dollar) (Board use only) (button) CLEAR (button) PRINT (Date) (Due on or before) (FOID) (Pacific time) except state holidays (Paid preparer's name) (Paid preparer's telephone number) (Telephone number) (text) (text) (text) (text) (text) (Your account number) [ FOID 1 Total (gross) sales 10; 90 for board use only 11 Total of exempt transactions (add lines 4 through 10) 111213 12 Taxable transactions (subtract line 11 from line 3) 13 Total sales and use tax [multiply line 12 by 16 Penalty (Multiply line 15 by 10% ( 10) if payment is made or your tax return is filed 17 Interest One month's interest is due on tax for each month or a fraction of 171816 4; 50 for board use only 2 Purchases subject to use tax 2nd prepayment$ = 3 Total (add lines 1 and 2) 4 Sales to other retailers for resale 5; 51 for board use only 6 Nontaxable labor (repair and installation) 6; 52 for board use only 7 Sales to the United States Government 7; 53 for board use only 8 Sales in interstate or foreign commerce 8; 54 for board use only 9 Sales tax (if any) included in line 1 9; 55 for board use only a month that payment is delayed after the due date The adjusted monthly a tax return may be submitted using the "Online Relief Requests" service adjusted monthly interest rate is indicated on line 17 of your return To after the due date shown above) PENALTY after the due date shown at the top of the return you must pay a 10 agency or instrumentality of the United States wholly owned by either aircraft and regulations from our website at www boe ca gov or call our Taxpayer available on our website at www boe ca gov under "eServices " Bad Debts on Taxable Sales Returned Taxable Merchandise Cash be exempt property must be shipped outside this state pursuant to because you used a resale or other exemption certificate to make the BOARD OF EQUALIZATION BOE 401 EZ (BACK) REV 33 (4 13) BOE 401 EZ (FRONT) REV 33 (4 13)STATE OF CALIFORNIA BOE USE ONLYRA TT LOCREG business (include all manner of sales) business day will be considered timely If you will be filing your return late business The purchase may have been made without payment of tax by the BOE ) Enter the prepayment amounts in the proper boxes This calculate the interest due multiply the amount on line 15 by the monthly carbonated beverages hot prepared food products meals or food collect California use tax; or you made a purchase from an unlicensed constitute labor charges for installing or applying property or for consumption in a place which is subject to an admission charge (see correct form Credit Card Payments You can use a Discover/Novus MasterCard VISA or American Express credit card to pay your taxes credit is limited to the amount of tax prepaid and should not include Discounts on Taxable Sales or Cost of Tax Paid Purchases Resold Prior DUE ON OR BEFORE DUE ON OR BEFORE eFile logo eFiling You can eFile your return When you eFile you can pay by credit card paper check or electronic check (ACH Debit) Equalization " Always write your account number on your check or money explained For more information see publication 61 Sales and Use fabricating or processing personal property for consumers (see facilities operated by the retailer; (2) delivery by the retailer to a carrier For more information go to www boe ca gov for shipment to a consignee at such a point; or (3) delivery by the form can be requested from our Taxpayer Information Section at 1 800 400 7115 from customers if those taxes were included in the amount shown on General Questions:You may download copies of forms publications I hereby certify that this return including any accompanying schedules and statements has been examined by If the above information is incorrect or your business has changed please call us at: incorporated federal instrumentalities not wholly owned by the United InformationSectionat 1 800 400 7115 (TTY:711) Customerservicerepresentatives are available weekdays from 8:00 a m to 5:00 p m INSTRUCTIONS STATE LOCAL AND DISTRICT SALES AND USE TAX RETURN (BOE 401 EZ) INTEREST interest rate isInterest Rate Calculator interest rate shown on line 17 then multiply this total by the number of involving shipments or deliveries from California to points outside this land banks and federal home loan banks (see Regulation 1614) line 1 (see Regulation 1700) Line 1 Total (Gross) Sales Report all sales related to your California Line 10 Other Deductions Enter the amount of all other deductions Line 11 Total Exempt Transactions Add lines 4 through 10 and enter Line 12 Taxable Transactions Subtract the amount on line 11 from Line 13 Total Sales and Use Tax Multiply line 12 by the tax rate Line 14 Tax Prepayments Complete this line only if you are required to Line 15 Remaining Tax Subtract line 14 from line 13 and enter the Line 16 Penalty If your tax payment is made or your tax return is filed line 17 Line 17 Interest If your payment is made after the due date shown at Line 18 Total Amount Due and Payable Add lines 15 16 and 17 Enter Line 2 Purchases Subject to Use Tax Enter the purchase price of line 3 and enter the remainder on line 12 Line 3 Total Enter total of lines 1 and 2 Line 4 Sales to Other Retailers for Resale Enter sales to other Line 5 Nontaxable Sales of Food Products Enter all sales of food Line 6 Nontaxable Labor Enter sales included in line 1 that Line 7 Sales to the United States Government Enter sales to: (1) Line 8 Sales in Interstate or Foreign Commerce Enter sales Line 9 Sales Tax Enter sales tax reimbursement or use tax collected made by calling 1 855 292 8931 or through our website at www boe ca gov Be sure to sign and mail your return Mail To: Make a copy for your records make tax prepayments (Businesses with average monthly taxable Make your check or money order payable to the "State Board of me and to the best of my knowledge and belief is a true correct and complete return merchandise equipment or other tangible personal property which months or fraction of a month payment is delayed Enter the amount on Nontaxable sales of food products Nontaxable sales of food products Nontaxable sales of food products not listed on lines 4 through 9 Each deduction must be clearly Note: If you are claiming a deduction for sales of food products by thepurchase ratiomethod you must maintain a complete analysis oftaxable and nontaxable purchases Note:Do not use this form if you have tax recovery deductions such as of the return to be considered timely If the due date falls on a Saturday or fraction of a month that payment is delayed after the due date The order Mail your return and payment in the envelope provided making Other credit cards cannot be accepted EFT accounts are not eligible for credit card payments Credit card payments can be Other deductions (clearly explain) PAID PREPARER'S PAID PREPARER'S NAME PAID PREPARER'S TELEPHONE NUMBER Partial State Tax Exemption If you have such transactions to report you penalty charges reported with your prepayments Add the first percent penalty Multiply line 15 by 10 and enter the result on line 16 Please read the instructions on the back of this form before completing this EZ return Important information on who can PLEASE ROUND CENTS TO THE NEAREST WHOLE DOLLAR PO BOX 942879 prepayment and the second prepayment Enter the total on line 14 printed for your business location Enter the result on line 13 products for human consumption Do not enter sales of alcoholic or purchase; you purchased from an out of state retailer who did not RA BTR AACS REFEFF Regulation 1546) Regulation 1668) Regulations 1602 and 1603 Vending machine operators should refer Remaining tax due (subtract line14 from line 13) repairs or reconditioning of tangible personal property to refit it for the result on line 15 retailer such as a person making an occasional sale of a vessel or an retailer to a customs broker or forwarding agent for shipment outside Returns and payments must be postmarked or received by the due date SACRAMENTO CA 94279 7072 SALES and USE TAX RETURN SALES and USE TAX RETURN sellers from whom you have taken valid resale certificates (see served by you for consumption at your facilities or food sold for SHORT FORM SHORT FORM SHORT FORM SALES and USE TAX RETURN should contact your local Board of Equalization (BOE) office for the Sign and Mail Your Return state that are exempt from tax as interstate or foreign commerce To States such as federal reserve banks federal credit unions federal States; (3) the American Red Cross its chapters and branches; (4) such as Treasury Interior Agriculture Defense; (2) any incorporated Sunday or state holiday returns postmarked or received by the next sure the BOE's address shows through the window Tax prepayments 1st prepayment Tax: Exemptions and Exclusions the contract of sale and delivered by the retailer by means of: (1) the top of your return you will owe one month's interest for each month the total amount of exempt transactions on line 11 the total on line 18 the United States or by a corporation wholly owned by the United the United States or its unincorporated agencies and instrumentalities this state (see Regulation 1620) to Regulation 1574) to Use Also this form should not be used if you have sales eligible for a Total amount due and payable (add lines 15 16 and 17) transactions of $17 000 or more must make prepayments once notified use for which it was originally produced Do not include charges for USE ONLY use the EZ return form is located in the instructions on line 10 If you are unable to use this EZ return the proper return You can eFile Payment by credit cards are accepted Please see instructions for further details you may qualify for an extension A request for an extension of time to file you purchased without paying California sales or use tax and which you used for purposes other than resale in the regular course of YOUR ACCOUNT NO YOUR ACCOUNT NO YOUR ACCOUNT NO YOUR SIGNATURE AND TITLE TELEPHONE NUMBER DATE