Form BOE-501-BWF Fillable Marine Invasive Species Fee Return

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(CLEAR ) CLEAR (First port or place only) (from Box A on Schedule A) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (LLOYD'S NUMBER) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT OR PLACE OF ARRIVAL IN CALIFORNIA (First port or place only)) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA) (PORT PRIOR TO ARRIVAL IN CALIFORNIA)) (PRINT ) PRINT (ROW 1 DATE OF ARRIVAL IN CALIFORNIA) (ROW 10 DATE OF ARRIVAL IN CALIFORNIA) (ROW 11 DATE OF ARRIVAL IN CALIFORNIA) (ROW 12 DATE OF ARRIVAL IN CALIFORNIA) (ROW 13 DATE OF ARRIVAL IN CALIFORNIA) (ROW 14 DATE OF ARRIVAL IN CALIFORNIA) (ROW 15 DATE OF ARRIVAL IN CALIFORNIA) (ROW 16 DATE OF ARRIVAL IN CALIFORNIA) (ROW 17 DATE OF ARRIVAL IN CALIFORNIA) (ROW 18 DATE OF ARRIVAL IN CALIFORNIA) (ROW 19 DATE OF ARRIVAL IN CALIFORNIA) (ROW 2 DATE OF ARRIVAL IN CALIFORNIA) (ROW 20 DATE OF ARRIVAL IN CALIFORNIA) (ROW 21 DATE OF ARRIVAL IN CALIFORNIA) (ROW 22 DATE OF ARRIVAL IN CALIFORNIA) (ROW 23 DATE OF ARRIVAL IN CALIFORNIA) (ROW 24 DATE OF ARRIVAL IN CALIFORNIA) (ROW 25 DATE OF ARRIVAL IN CALIFORNIA) (ROW 26 DATE OF ARRIVAL IN CALIFORNIA) (ROW 27 DATE OF ARRIVAL IN CALIFORNIA) (ROW 28 DATE OF ARRIVAL IN CALIFORNIA) (ROW 29 DATE OF ARRIVAL IN CALIFORNIA) (ROW 3 DATE OF ARRIVAL IN CALIFORNIA) (ROW 30 DATE OF ARRIVAL IN CALIFORNIA) (ROW 31 DATE OF ARRIVAL IN CALIFORNIA) (ROW 32 DATE OF ARRIVAL IN CALIFORNIA) (ROW 4 DATE OF ARRIVAL IN CALIFORNIA) (ROW 5 DATE OF ARRIVAL IN CALIFORNIA) (ROW 6 DATE OF ARRIVAL IN CALIFORNIA) (ROW 7 DATE OF ARRIVAL IN CALIFORNIA) (ROW 8 DATE OF ARRIVAL IN CALIFORNIA) (ROW 9 DATE OF ARRIVAL IN CALIFORNIA) (TOTAL VOYAGES Enter the total number of voyages subject to the fee and carry this amount to Line 1 on the front of the return BOX A) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) (VESSEL NAME) [ FOID ] 1 Number of vessel voyages subject to the Marine Invasive Species fee for the month 1 2 Rate of fee per voyage 2 $ 3 Total amount due (multiply line 1 by amount shown on line 2) 3 $ 00 4 Penalty [multiply line 3 by 10% (0 10) if payment is made after due date] PENALTY 4 $ 5 INTEREST: One month's interest is due on the total fee for each month or fraction of a month that payment 6 TOTAL AMOUNT DUE AND PAYABLE (add lines 3 4 and 5) 6 $ 00 Always write your account number on your check or money order Make a copy of this document for your records and carry this amount to Line 1 ARRIVAL IN ARRIVAL IN CALIFORNIA arrived at a California port from a port outside of California during the reporting period authorized to collect the fee for deposit into the Marine Invasive Species Control Fund The fee is due from the owner or BEFORE PREPARING BOARD OF EQUALIZATION BOE 501 BWF (BACK) REV 9 (4 13) BOE 501 BWF (FRONT) REV 9 (4 13) BOE USE ONLY BOX A CALIFORNIA DATE OF DUE ON OR BEFORE EMAIL ADDRESS Enter the total number of Enter the total number of voyages subject to the fee in Box A and carry that number forward to line 1 on the return examined by me and to the best of my knowledge and belief is a true correct and complete return Existing law authorizes the State Lands Commission to impose a fee on owners or operators of vessels for the purpose FILING INSTRUCTIONS FILING REQUIREMENTS GENERAL INFORMATION go to our website or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and I hereby certify that this return including any accompanying schedules and statements has been IF MORE SPACE IS NEEDED YOU MAY MAKE A PHOTOCOPY AND ATTACH ANY ADDITIONAL PAGES INTEREST 5 $ is delayed after the due date The adjusted monthly interest rate is LLOYD'S NUMBER mail your return Make check or money order payable to State Board of Equalization MARINE INVASIVE SPECIES FEE RETURN Multiply line 1 by line 2 to determine the amount due nearest whole dollar of California during the reporting period Each such arrival is a voyage that is subject to the Marine Invasive Species fee of funding a program for the management of ballast water discharge The State Board of Equalization (BOE) is of the return reporting period Schedule A must be completed to provide the information requested for each vessel that on the front of the return operator of a vessel every time that vessel arrives at a California port from a port outside of California Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go Please complete Schedule A attached List in date order all vessels that arrived at a California port from a port outside PO BOX 942879 PORT OR PLACE OF PORT PRIOR TO RA B/A AUD REG READ INSTRUCTIONS Round cents to the RR QS FILE REF SACRAMENTO CA 94279 6001 SCHEDULE A MARINE INVASIVE SPECIES FEE SCHEDULE SIGNATURE PRINT NAME AND TITLE TELEPHONE SPECIAL STATE OF CALIFORNIA TAXES This return must be filed and the fees paid to the BOE on or before the last day of the calendar month following the end to our website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card TOTAL VOYAGES VESSEL NAME voyages subject to the fee YOUR ACCOUNT NO

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