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Form BOE-501-TK Fillable Underground Storage Tank Maintenance Fee Return
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(1 Total gallons of petroleum products placed in all tanks owned Do not report tank capacity ) (3 Total fee due (multiply line 1 by line 2) $) (4 PENALTY [multiply line 3 by 10% (0 10) if payment made or return filed after the due date shown above] $) (5 INTEREST $) (5 INTEREST: One month's interest is due on tax for each month or fraction of a month that payment is delayed after the due date The adjusted monthly interest rate is ) (6 TOTAL AMOUNT DUE AND PAYABLE (add lines 3 4 and 5) $ ) (BOE USE ONLY) (checkbox) (CLEAR) CLEAR (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (PRINT NAME AND TITLE) (PRINT) PRINT (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (YOUR ACCOUNT NO ) [ FOID ] 1 Total gallons of petroleum products placed in all tanks owned 2 Rate of fee 2 023 Total fee due (multiply line 1 by line 2) 3 $ 4 Penalty [multiply line 3 by 10% (0 10) if payment made or return filed after 5 INTEREST:One month's interest is due on tax for each month or fraction of a 6 TOTAL AMOUNT DUE AND PAYABLE (add lines 3 4 and 5) 6 $ Always write your account number on your check or money order Make a copy of this document for your records BEFORE PREPARING BOARD OF EQUALIZATION BOARD OF EQUALIZATIONSPECIAL TAXES AND FEESP O BOX 942879SACRAMENTO CA 94279 6151 BOE 501 TK REV 12 (4 13)STATE OF CALIFORNIA BOE USE ONLY covered by the return Do not report tank capacity The return is due on or before the 25th day of the month Do not report tank capacity 1 DUE ON OR BEFORE EMAIL ADDRESS Every owner of an underground storage tank shall file an underground storage tank maintenance fee return examined by me and to the best of my knowledge and belief is a true correct and complete return example tanks that are empty or not in use FILING REQUIREMENTS following the end of the reporting period A return must be filed even though you have no liability for the fee for I hereby certify that this return including any accompanying schedules and statements has been If you have sold or removed any of your tanks or have moved please notify this office If you are not the tank interest rate is INTEREST5 $ Make check or money order payable to State Board of Equalization month that payment is delayed after the due date The adjusted monthly owner please indicate the current owner's full name and address on an attachment and forward along with this Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our RA B/A AUDREG READ INSTRUCTIONS return RR QS FILEREF showing the total number of gallons of petroleum products placed into the owner's tanks during the period SIGNATURE PRINT NAME AND TITLE TELEPHONE the due date shown above] PENALTY4 $ UNDERGROUND STORAGE TANK MAINTENANCE FEE RETURN website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card go to our websiteor call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return YOUR ACCOUNT NO