Form BOE-512 Fillable Annual Flat Rate Fuel Tax Renewal

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$ 120 00$ $ 168 00$ $ 36 00$ $ 72 00$ $120 fee and enter the result in column C $36 00$ (3 More than 4 000 lbs but less than 8 001 lbs COLUMN A NUMBER OF VEHICLES ) (4 More than 8 000 lbs but less than 12 001 lbs COLUMN A NUMBER OF VEHICLES ) (5 More than 12 000 lbs COLUMN A NUMBER OF VEHICLES ) (Account Number) (CLEAR) CLEAR (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN B YEAR ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C LICENSE NUMBER ) (COLUMN C TOTAL FEES (column A x B) $ ) (COLUMN C TOTAL FEES (column A x B) $ ) (COLUMN C TOTAL FEES (column A x B) $ ) (COLUMN C TOTAL FEES (column A x B) $ ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN D UNLADEN WEIGHT ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN E TYPE OF FUEL USED ) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (COLUMN F FEE $) (CONTINUE) CONTINUE (DATE) (Decal Number) (EMAIL ADDRESS) (EXPIRES AT THE END OF) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (INDICATE R Renewal N New) (Name) (PRINT NAME AND TITLE) (PRINT) PRINT (ROW 1 COLUMN A MAKE ) (ROW 10 COLUMN A MAKE ) (ROW 11 COLUMN A MAKE ) (ROW 12 COLUMN A MAKE ) (ROW 13 COLUMN A MAKE ) (ROW 14 COLUMN A MAKE ) (ROW 15 COLUMN A MAKE ) (ROW 16 COLUMN A MAKE ) (ROW 17 COLUMN A MAKE ) (ROW 18 COLUMN A MAKE ) (ROW 19 COLUMN A MAKE ) (ROW 20 COLUMN A MAKE ) (ROW 21 COLUMN A MAKE ) (ROW 22 COLUMN A MAKE ) (ROW 23 COLUMN A MAKE ) (ROW 24 COLUMN A MAKE ) (ROW 25 COLUMN A MAKE ) (ROW 26 COLUMN A MAKE ) (ROW 27 COLUMN A MAKE ) (ROW 28 COLUMN A MAKE ) (ROW 3 COLUMN A MAKE ) (ROW 4 COLUMN A MAKE ) (ROW 5 COLUMN A MAKE ) (ROW 6 COLUMN A MAKE ) (ROW 7 COLUMN A MAKE ) (ROW 8 COLUMN A MAKE ) (ROW 9 COLUMN A MAKE ) (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (text) 432 (TOTAL FEES ENCLOSED $) (TYPE OF VEHICLES VEHICLES WITH AUTOMOBILE LICENSE PLATES 1 Passenger vehicles and other vehicles with automobile plates COLUMN A NUMBER OF VEHICLES ) (VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) 2 4 000 lbs or less COLUMN A NUMBER OF VEHICLES ) (YOUR ACCOUNT NO ) [ FOID ] 1 If all vehicles are presently operated by either LPG LNG or CNG make no changes 1 Passenger vehicles and other vehicles with automobile plates 1 12 000 pounds and enter the total in column A Multiply the number of vehicles by the $168 fee and enter the result in 2 4 000 lbs or less 2 2 If any vehicles listed are no longer in operation or are no longer powered by LPG LNG or CNG delete them by 3 If you wish to add a vehicle(s) which is not already listed on the Supplemental Vehicle List enter the complete 3 More than 4 000 lbs but less than 8 001 lbs 3 4 000 pounds but less than 8 001 pounds and enter the total in column A Multiply the number of vehicles by the $72 4 If you sell or otherwise transfer any vehicle during a year for which you have already paid the flat rate fuel tax you 4 More than 8 000 lbs but less than 12 001 lbs 4 5 More than 12 000 lbs 5 6 Total number of vehicles (add lines 1 through 5 in column A) 6 7 TOTAL FEES ENCLOSED (add lines 1 through 5 in column C) 7 8 000 pounds but less than 12 001 pounds and enter the total in column A Multiply the number of vehicles by the 94279 0065 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at 1 800 400 7115 (TTY:711); from A BCTYPE OF VEHICLES NUMBER OF VEHICLES FEETOTAL FEES(column A x B) Account Number Always write your account number on your check or money order Make a copy of this document for your records amount in column F ANNUAL FLAT RATE FUEL TAX RENEWAL are renewable by that month of the following year For example if the starting month of the account is "March " the 12 month AUD REG be required to file a return showing the total number of gallons used in vehicles for which the flat rate fee has been paid BEFORE PREPARING BOARD OF EQUALIZATION BOARD OF EQUALIZATIONMOTOR CARRIER OFFICEP O BOX 942879SACRAMENTO CA 94279 6191 BOE 512 (S1B) REV 4 (4 13) BOE 512 (S1F) REV 4 (4 13)STATE OF CALIFORNIA BOE 512 (S2B) REV 4 (4 13) BOE 512 (S2F) REV 4 (4 13) BOE USE ONLY BOE USE ONLY(Decal Number) by visiting our website at www boe ca gov or by contacting the Taxpayer Information Section at 1 800 400 7115 (TTY:711) Chevrolet C LICENSE NUMBER Z73700 Chevrolet Chevrolet B YEAR 72 Chevrolet D UNLADEN WEIGHT 8220 Chevrolet E TYPE OF FUEL USED CNG Chevrolet F FEE $ 120 00 Chevrolet INDICATE R Renewal N New R Column A Indicate the make of vehicle for which you are applying for an Annual Flat Rate Decal Column B Indicate the year of the vehicle for which you are applying for an Annual Flat Rate Decal column C Column C Indicate the license number of the vehicle for which you are applying for the Annual Flat Rate Decal Column D Does not apply to vehicles with automobile license plates Fees for all vehicles with commercial plates and Column E Use initials for fuel type: Liquefied Petroleum Gas LPG Column F The fee schedule is based upon unladen weight of vehicles which are subject to weight fees Enter the correct Complete the enclosed Supplemental Vehicle List before completing the renewal form Full payment must accompany Compressed Natural Gas CNG DECAL MAY NOT BE TRANSFERRED TO ANOTHER VEHICLE drawing a line through the entire entry for vehicle(s) EXPIRES AT THE END OF fee and enter the result in column C FEE SCHEDULE EXAMPLE FILE REF FILING INSTRUCTIONS FILING REQUIREMENTS Flat rate fuel decals are issued for 12 month periods beginning with the same starting month as the Use Fuel Tax account and Ford C LICENSE NUMBER 00737A Ford D UNLADEN WEIGHT 6072 Ford E TYPE OF FUEL USED LPG Ford F FEE $ 72 00 Ford Ford B YEAR 78 Ford INDICATE R Renewal N New R form Upon receipt of payment of the required fee the Board of Equalization (BOE) will issue a decal BOE 511 Use Fuel Flat Rate fuel tax to vendors To qualify for payment of the annual flat rate tax the user must have a Use Fuel Tax Permit and complete this FUEL USED fuels [liquefied petroleum gas (LPG) liquid natural gas (LNG) compressed natural gas (CNG)] for those vehicles without paying use GENERAL INFORMATION I certify under the laws of the State of California that the foregoing is true and correct I understand that the tax fee applies to a specific vehicle and is not subject to refund or transfer to another vehicle and that I may Identification Decal for each qualified vehicle identifies the vehicle for the purpose of purchasing alternative fuels from vendors without payment of the use fuel tax If you need additional information please contact the State Board of Equalization Motor Carrier Office P O Box 942879 Sacramento CA INDICATE information about the vehicle(s) in the spaces provided at the end of the printed list See below for further instructions INSTRUCTIONS ANNUAL FLAT RATE FUEL TAX RENEWAL INSTRUCTIONS FOR SUPPLEMENTAL VEHICLE LIST LICENSE NUMBER Line 1 Add the number of passenger vehicles listed on the Supplemental Vehicle List and enter the total in column A Line 2 Add the number of commercial vehicles listed on the Supplemental Vehicle List with an unladen weight of 4 000 Line 3 Add the number of commercial vehicles listed on the Supplemental Vehicle List with an unladen weight of more than Line 4 Add the number of commercial vehicles listed on the Supplemental Vehicle List with an unladen weight of more than Line 5 Add the number of commercial vehicles listed on the Supplemental Vehicle List with an unladen weight of more than Line 6 Add lines 1 through 5 in column A Line 7 Add lines 1 through 5 in column C Liquid Natural Gas LNG Make changes if name Make check or money order payable to State Board of Equalization Multiply the number of vehicles by the $36 fee and enter the result in column C must report the transfer to the State Board of Equalization's Motor Carrier Office within ten (10) days N New or address is incorrect P O Box 942879 Sacramento CA 94279 0065 telephone 1 800 400 7115 (TTY:711) Paying the annual flat rate fuel tax for the vehicles identified on the Supplemental Vehicle List will entitle you to purchase alternative Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our period for which a decal is issued begins in March and ends in February of the following year For vehicles added partway through Please complete the Supplemental Vehicle List as shown in the example You may print or type the required information Plymouth C LICENSE NUMBER SAM123 Plymouth D UNLADEN WEIGHT Plymouth E TYPE OF FUEL USED LPG Plymouth F FEE $ 36 00 Plymouth INDICATE R Renewal N New R Plymouth Plymouth B YEAR 64 pounds or less and enter the total in column A Multiply the number of vehicles by the $36 fee and enter the result in PREPARATION OF RENEWAL PRINT NAME AND TITLE R Renewal RA B/A READ INSTRUCTIONS Read instructions before preparing See reverse for instructions and fee schedule example Read instructions on reverse before preparing this form RR QS SIGNATUREEMAIL ADDRESS STATE OF CALIFORNIA subject to weight fees are determined by the unladen weight of the vehicle which must agree with the unladen SUPPLEMENTAL VEHICLE LIST TELEPHONE() the 12 month period BOE 512 AD Request for Additional Annual Flat Rate Decals must be completed You may request this form the application If you need additional information please contact the Motor Carrier Office State Board of Equalization The fees and/or the decals may not be transferred to another vehicle and no portion of the fee may be refunded The decal the main menu select the option Special Taxes and Fees this renewal application TOTAL FEES ENCLOSED TOTAL FEES ENCLOSED TOTAL FEES ENCLOSED F FEE $264 00 Total the vehicles by make Transfer the total number of vehicles to the proper line (1 through 5 in column A) on the front of TYPE OF UNLADEN VEHICLES WITH AUTOMOBILE LICENSE PLATES VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) 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 website or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return WEIGHT weight shown on the vehicle registration card or ownership certificate Winnebago C LICENSE NUMBER 2SAM123 Winnebago D UNLADEN WEIGHT Winnebago E TYPE OF FUEL USED LNG Winnebago F FEE $ 36 00 Winnebago INDICATE R Renewal N New N Winnebago Winnebago B YEAR 89 YOUR ACCOUNT NO

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