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Form BOE-506-PC Fillable Petroleum Carrier Report
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)((a) COMPANY NAME) ((c) PRODUCT CODE) ((d) MONTH/YEAR) (6) DOCUMENT NUMBER TOTAL (a) COMPANY NAME (a) COMPANY NAME (b) BOE ACCOUNT NUMBER (c) PRODUCT CODE (d) MONTH/YEAR (b) BOE ACCOUNT NUMBER (BOE USE ONLY ) (button) CONTINUE (c) PRODUCT CODE (d) MONTH/YEAR (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (If additional space is needed please photocopy the schedule before making entries ) (Page) (PRINT NAME AND TITLE) (row 1; Column 1; Consignor Name) (row 1; Column 2; Consignor FEIN) (row 1; Column 3; Mode) (row 1; Column 4; Origin Terminal TCN) (row 1; Column 5; Document Date) (row 1; Column 6; Document Number) (row 1; Column 7; Net Gallons) (row 10; Column 1; Consignor Name) (row 10; Column 2; Consignor FEIN) (row 10; Column 3; Mode) (row 10; Column 4; Origin Terminal TCN) (row 10; Column 5; Document Date) (row 10; Column 6; Document Number) (row 10; Column 7; Net Gallons) (row 11; Column 1; Consignor Name) (row 11; Column 2; Consignor FEIN) (row 11; Column 3; Mode) (row 11; Column 4; Origin Terminal TCN) (row 11; Column 5; Document Date) (row 11; Column 6; Document Number) (row 11; Column 7; Net Gallons) (row 12; Column 1; Consignor Name) (row 12; Column 2; Consignor FEIN) (row 12; Column 3; Mode) (row 12; Column 4; Origin Terminal TCN) (row 12; Column 5; Document Date) (row 12; Column 6; Document Number) (row 12; Column 7; Net Gallons) (row 13; Column 1; Consignor Name) (row 13; Column 2; Consignor FEIN) (row 13; Column 3; Mode) (row 13; Column 4; Origin Terminal TCN) (row 13; Column 5; Document Date) (row 13; Column 6; Document Number) (row 13; Column 7; Net Gallons) (row 14; Column 1; Consignor Name) (row 14; Column 2; Consignor FEIN) (row 14; Column 3; Mode) (row 14; Column 4; Origin Terminal TCN) (row 14; Column 5; Document Date) (row 14; Column 6; Document Number) (row 14; Column 7; Net Gallons) (row 15; Column 1; Consignor Name) (row 15; Column 2; Consignor FEIN) (row 15; Column 3; Mode) (row 15; Column 4; Origin Terminal TCN) (row 15; Column 5; Document Date) (row 15; Column 6; Document Number) (row 15; Column 7; Net Gallons) (row 16; Column 1; Consignor Name) (row 16; Column 2; Consignor FEIN) (row 16; Column 3; Mode) (row 16; Column 4; Origin Terminal TCN) (row 16; Column 5; Document Date) (row 16; Column 6; Document Number) (row 16; Column 7; Net Gallons) (row 17; Column 1; Consignor Name) (row 17; Column 2; Consignor FEIN) (row 17; Column 3; Mode) (row 17; Column 4; Origin Terminal TCN) (row 17; Column 5; Document Date) (row 17; Column 6; Document Number) (row 17; Column 7; Net Gallons) (row 18; Column 1; Consignor Name) (row 18; Column 2; Consignor FEIN) (row 18; Column 3; Mode) (row 18; Column 4; Origin Terminal TCN) (row 18; Column 5; Document Date) (row 18; Column 6; Document Number) (row 18; Column 7; Net Gallons) (row 19; Column 1; Consignor Name) (row 19; Column 2; Consignor FEIN) (row 19; Column 3; Mode) (row 19; Column 4; Origin Terminal TCN) (row 19; Column 5; Document Date) (row 19; Column 6; Document Number) (row 19; Column 7; Net Gallons) (row 2; Column 1; Consignor Name) (row 2; Column 2; Consignor FEIN) (row 2; Column 3; Mode) (row 2; Column 4; Origin Terminal TCN) (row 2; Column 5; Document Date) (row 2; Column 6; Document Number) (row 2; Column 7; Net Gallons) (row 20; Column 1; Consignor Name) (row 20; Column 2; Consignor FEIN) (row 20; Column 3; Mode) (row 20; Column 4; Origin Terminal TCN) (row 20; Column 5; Document Date) (row 20; Column 6; Document Number) (row 20; Column 7; Net Gallons) (row 21; Column 1; Consignor Name) (row 21; Column 2; Consignor FEIN) (row 21; Column 3; Mode) (row 21; Column 4; Origin Terminal TCN) (row 21; Column 5; Document Date) (row 21; Column 6; Document Number) (row 21; Column 7; Net Gallons) (row 22; Column 1; Consignor Name) (row 22; Column 2; Consignor FEIN) (row 22; Column 3; Mode) (row 22; Column 4; Origin Terminal TCN) (row 22; Column 5; Document Date) (row 22; Column 6; Document Number) (row 22; Column 7; Net Gallons) (row 23; Column 7; Net Gallons TOTAL) (row 3; Column 1; Consignor Name) (row 3; Column 2; Consignor FEIN) (row 3; Column 3; Mode) (row 3; Column 4; Origin Terminal TCN) (row 3; Column 5; Document Date) (row 3; Column 6; Document Number) (row 3; Column 7; Net Gallons) (row 4; Column 1; Consignor Name) (row 4; Column 2; Consignor FEIN) (row 4; Column 3; Mode) (row 4; Column 4; Origin Terminal TCN) (row 4; Column 5; Document Date) (row 4; Column 6; Document Number) (row 4; Column 7; Net Gallons) (row 5; Column 1; Consignor Name) (row 5; Column 2; Consignor FEIN) (row 5; Column 3; Mode) (row 5; Column 4; Origin Terminal TCN) (row 5; Column 5; Document Date) (row 5; Column 6; Document Number) (row 5; Column 7; Net Gallons) (row 6; Column 1; Consignor Name) (row 6; Column 2; Consignor FEIN) (row 6; Column 3; Mode) (row 6; Column 4; Origin Terminal TCN) (row 6; Column 5; Document Date) (row 6; Column 6; Document Number) (row 6; Column 7; Net Gallons) (row 7; Column 1; Consignor Name) (row 7; Column 2; Consignor FEIN) (row 7; Column 3; Mode) (row 7; Column 4; Origin Terminal TCN) (row 7; Column 5; Document Date) (row 7; Column 6; Document Number) (row 7; Column 7; Net Gallons) (row 8; Column 1; Consignor Name) (row 8; Column 2; Consignor FEIN) (row 8; Column 3; Mode) (row 8; Column 4; Origin Terminal TCN) (row 8; Column 5; Document Date) (row 8; Column 6; Document Number) (row 8; Column 7; Net Gallons) (row 9; Column 1; Consignor Name) (row 9; Column 2; Consignor FEIN) (row 9; Column 3; Mode) (row 9; Column 4; Origin Terminal TCN) (row 9; Column 5; Document Date) (row 9; Column 6; Document Number) (row 9; Column 7; Net Gallons) (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (YOUR ACCOUNT NO ) [ FOID] 800 400 7115 (TTY: 711); from the main menu select the option Special Taxes and Fees and to the best of my knowledge and belief is a true correct and complete report As a vessel pipeline or train operator you are required to report receipts and deliveries of petroleum AUD REG B Barge BEFORE PREPARING being involved in a reported transaction for the sole purpose of verifying the accuracy of the reportable product BOARD OF EQUALIZATION BOARD OF EQUALIZATIONSPECIAL TAXES AND FEESPO BOX 942879 BOE 506 PC (S1B) REV 4 (3 11) BOE 506 PC (S1F) REV 4 (3 11)STATE OF CALIFORNIA BOE 506 PC (S2B) REV 4 (3 11) BOE 506 PC (S2F) REV 4 (3 11) BOE USE ONLY calendar month following the reporting period to which it relates You must file a report even if you have no activity for the Carrier Deliveries Report only one product code per page (Photocopy the schedules if additional pages are needed to Carrier Deliveries Schedule 14E to report Carrier Receipts Schedule 14D to report certain otherwise confidential transaction information regarding volumes invoice numbers bills of lading CERTIFICATION Column 1 Enter the name of the consignor Column 2 Enter the consignor's FEIN (Federal Employer Identification Number) Column 3 Enter the mode from the mode codes list below Column 4 Enter the origination TCN from which product was received or the destination TCN to which product was Column 5 Enter the date of the document identified in column 6 (enter as mm/dd/yy) Column 6 Enter the identifying number from the document provided by the terminal operator or refinery to the carrier Column 7 Enter the net gallons for the transaction CONSIGNOR CONSIGNOR deliveries of liquid petroleum product for product movements originating and/or terminating in California destination on Schedule 14E When the origin or destination is a terminal enter the IRS Terminal Control Number (TCN) DESTINATION TERMINAL disbursed for each product movement DOCUMENT DOCUMENT DUE ON OR BEFORE FILE REF FILING REQUIREMENTS For each bulk movement of a reportable product please enter the point of origin on Schedule 14D and the point of GALLONS GENERAL INFORMATION I hereby certify that this report including all accompanying schedules and statements has been examined by me I hereby consent to disclosure and authorize the State Board of Equalization (BOE) to release as necessary If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 INSTRUCTIONS is not a bill of lading use the shipping document or manifest number Both the carrier and the terminal issued for that terminal When the origin or destination is other than a terminal (that is importation or exportation) enter locations dates or method of delivery of reportable products to any person identified by me in this report as Make a copy of this document and the accompanying schedules for your records Mode Codes No activity to report NUMBER of the schedule Your company name account number and month/year are pre filled when you receive monthly paper operator must report the same document number to the BOE ORIGIN TERMINAL origination or destination is not an IRS approved terminal with a TCN our website ) Train operators should report the origination and destination city and state for each transaction when the Page of permit you to report only one product code per page ) For each schedule enter the product code in box (c) in the header PETROLEUM CARRIER REPORT petroleum products that originate and/or terminate in the state The report must be filed on or before the last day of the PL Pipeline Please check the applicable boxes: PREPARATION OF SCHEDULES 14D AND 14E PRINT NAME AND TITLE product received or delivered during the reporting period Vessel barge and pipeline operators must report all petroleum products into out of and within California terminals for the reporting period products received at or delivered to California terminals or refineries Train operators must report all movements of R Railroad RA B/A READ INSTRUCTIONS REFREF REGREG REPORTING ORIGIN AND DESTINATION reporting period returns from the BOE RR QS S Ship (ocean marine vessel) Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at SACRAMENTO CA 94279 2074 SCHEDULE 14D CARRIER RECEIPTS SCHEDULE 14E CARRIER DELIVERIES SCHEDULES 14D CARRIER RECEIPTS AND 14E CARRIER DELIVERIES SIGNATUREEMAIL ADDRESS sorted by product type is available in BOE 810 FTB STATE OF CALIFORNIA TELEPHONE( ) that reflects the details of the transaction Except for train operators this should be a bill of lading If there The most current list of product codes is available in numeric order on the BOE's website in BOE 810 FTA The same list The Petroleum Carrier Report allows transport operators (vessel barge pipeline and train operator) to report receipts and the two character U S Postal Service abbreviation (obtain from BOE 810 FTC Postal Abbreviations Table available on TOTAL Train operators should report the railcar information as prescribed by the BOE transaction information concerning my transactions with such person as reported in this report transported by vessel pipeline or train received from or delivered to a location in California Two schedules are included with every Petroleum Carrier Report: Schedule 14D Carrier Receipts and Schedule 14E Use Schedule 14D to report the origination and Schedule 14E to report the destination of liquid petroleum product Vessel barge pipeline and train operators must file a report with the BOE reporting every gallon of petroleum fuel YOUR ACCOUNT NO