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Form BOE-504-C Fillable Statement Concerning Property Purchased Without Payment of CA Sales Tax
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(Auditor's Initials) (City) (Comments) (Date) (DMA) (Nature of Business) (Phone) (Purchaser's Name) (Purchaser's Sales Tax Permit Number) (reporting period) (Row 1 Column 2 Invoice Number) (Row 1 Column 3 Purchase Order Number) (Row 1 Column 4 Amount) (Row 1 Column 5 Description) (Row 1 PRODUCT MANUFACTURER) (Row 2 Column 2 Invoice Number) (Row 2 Column 3 Purchase Order Number) (Row 2 Column 4 Amount) (Row 2 Column 5 Description) (Row 3 Column 2 Invoice Number) (Row 3 Column 3 Purchase Order Number) (Row 3 Column 4 Amount) (Row 3 Column 5 Description) (Row 4 Column 2 Invoice Number) (Row 4 Column 3 Purchase Order Number) (Row 4 Column 4 Amount) (Row 4 Column 5 Description) (Row 5 Column 2 Invoice Number) (Row 5 Column 3 Purchase Order Number) (Row 5 Column 4 Amount) (Row 5 Column 5 Description) (tax amount) (Title) AMOUNT DESCRIPTION any purpose other than retention demonstration or display while being held for sale in the regular course of business Auditor AuditorAuditor below Please fill out the form completely check the appropriate boxes and sign as your company s authorized representative BOARD OF EQUALIZATION BOE 504 C REV 12 (1 97) STATE OF CALIFORNIA COMMENTS DATE INVOICE DMA DMA NAME OF SELLER FROM WHOM YOU PURCHASED ITEMS WITHOUT SALES TAX NATURE OF BUSINESS NUMBER ORDER our sales tax returns PHONE Please check the appropriate box(es) below If none of these apply please explain below Please complete this inquiry statement to indicate the disposition of certain non taxed purchases you made from the seller listed PURCHASE PURCHASER S NAME PURCHASER S SALES TAX PERMIT NUMBER s Initials s Initials s Initials SELLER S PERMIT NUMBER SIGNATURETITLE STATEMENT CONCERNING PROPERTY PURCHASED STATEMENT CONCERNING PROPERTY PURCHASED STATEMENT CONCERNING PROPERTY PURCHASED tax in the amount of was added to the billing and remitted to the Seller tax in the amount of was paid directly to the Board with our sales tax return for the reporting period than retention demonstration or display while being held for sale in the regular course of business The above property was purchased for leasing and tax measured by rental receipts has been paid directly to the Board with The above property was purchased for our own use and not for resale; and The above property was purchased for resale and is presently in resale inventory It has not been used for any purpose other The above property was purchased for resale and was resold in the form of tangible personal property It was not used for The form should be returned within 10 days The information provided above is subject to verification by the State Board of Equalization the purchase is a taxable transaction and tax is applicable WITHOUT PAYMENT OF CALIFORNIA SALES TAX WITHOUT PAYMENT OF CALIFORNIA SALES TAX WITHOUT PAYMENT OF CALIFORNIA SALES TAX