Form BOE-512-AD Fillable Request for Additional Annual Flat Rate Decals

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Download Form BOE-512-AD

View all CA - California Sales, Use and Other Taxes

(1 Enter the number of additional use fuel vehicles for which you are requesting decals ) (2 Enter the total amount of prorated fees for additional decals requested ) (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 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 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) (CONTINUE) CONTINUE (DATE) (Decal Number) (EMAIL ADDRESS) (EXPIRES AT THE END OF) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (F FEE $) (Name) (PRINT NAME AND TITLE) (PRINT) CLEAR (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 2 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 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) (TOTAL FEES ENCLOSED $) (YOUR ACCOUNT NO ) [ FOID ] 1 800 400 7115 (TTY:711); from the main menu select the option Special Taxes and Fees 1 Enter the number of additional use fuel vehicles for which you are requesting decals 2 Enter the total amount of prorated fees for additional decals requested Account Number administration of the annual flat rate fuel tax program requires that when additional vehicles are added the fees shall be Always write your account number on your check or money order Make a copy of this document for your records amount of fees enclosed on line 2 on the front of the request be in good standing been paid BEFORE PREPARING Before preparing read instructions on reverse and follow fee schedule example BOARD OF EQUALIZATION BOARD OF EQUALIZATION BOE 512 AD (S1) REV 4 (4 13) STATE OF CALIFORNIA BOE 512 AD (S2B) REV 4 (4 13) BOE 512 AD (S2F) REV 4 (4 13) BOE USE ONLY Chevrolet Chevrolet B YEAR 72 Chevrolet C LICENSE NUMBER Z73700 Chevrolet D UNLADEN WEIGHT 8220 Chevrolet E TYPE OF FUEL CNG Chevrolet F FEE $ 70 00 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 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 To calculate Compressed Natural Gas CNG DECALS MAY NOT BE TRANSFERRED TO ANOTHER VEHICLE EMAIL ADDRESS EXPIRES AT THE END OF FEE $ 120 00 FEE $ 168 00 FEE $ 36 00 FEE $ 72 00 FEE SCHEDULE FEE SCHEDULE EXAMPLE FILING INSTRUCTIONS FILING REQUIREMENTS first day of the month in which the payment was made and ending one year thereafter The BOE in order to facilitate the Ford B YEAR 78 Ford C LICENSE NUMBER 00737A Ford D UNLADEN WEIGHT 6072 Ford E TYPE OF FUEL LPG Ford F FEE $ 42 00 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 If you need additional information please contact the State Board of Equalization Motor Carrier Office P O Box 942879 INSTRUCTIONS FOR SUPPLEMENTAL VEHICLE LIST LICENSE NUMBER Line 1 Add the number of use fuel vehicles listed on the Supplemental Vehicle List and enter the total on line 1 Line 2 Add the fees (column F) for the vehicles listed on the Supplemental Vehicle List and enter the total amount on line 2 Liquid Natural Gas LNG Make check or money order payable to State Board of Equalization March would be seven twelfths (7/12) of the appropriate fee may be required to file a return showing the total number of gallons used in vehicles for which the flat rate fee has been paid month of the 12 month period For example the fee for a vehicle added in August to an account with a starting month of MOTOR CARRIER OFFICE of purchasing liquefied petroleum gas (LPG) liquid natural gas (LNG) or compressed natural gas (CNG) without payment of the of the 12 month period and enter the result in column F part way through the 12 month period is reduced by one twelfth (1/12) for each month which has passed since the starting PAYMENT MUST ACCOMPANY THE REQUEST Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our PLEASE COMPLETE THE ENCLOSED SUPPLEMENTAL VEHICLE LIST BEFORE COMPLETING THIS FORM FULL Please complete the Supplemental Vehicle List as shown in the example below You may print or type the required information Plymouth Plymouth B YEAR 64 Plymouth C LICENSE NUMBER SAM123 Plymouth D UNLADEN WEIGHT Plymouth E TYPE OF FUEL LPG Plymouth F FEE $ 21 00 PO BOX 942879 PRINT NAME AND TITLE prorated so that vehicles under the same use fuel tax account will have a like starting month The fee for vehicles added READ INSTRUCTIONS Reduce the fee by one twelfth (1/12) for each month which has passed since the starting month REQUEST FOR ADDITIONAL ANNUAL FLAT RATE DECALS Sacramento CA 94279 0065 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at SACRAMENTO CA 94279 6192 SIGNATURE STATE OF CALIFORNIA subject to weight fees are determined by the unladen weight of the vehicle which must agree with the SUPPLEMENTAL VEHICLE LIST TELEPHONE the fee due on each additional vehicle please complete the following formula: The fees and/or the decals may not be transferred from one vehicle to another The decal identifies the vehicle for the purpose The flat rate is an annual tax The period for which the annual fee payment applies is any 12 month period beginning with the TOTAL FEES ENCLOSED TOTAL FEES ENCLOSED $ TOTAL FEES ENCLOSED F FEE $ 154 00 Total the vehicles by type Transfer the total number of vehicles to line 1 on the front of the request Enter the total TYPE OF TYPE OF FUEL TYPES OF VEHICLES AND FEES SCHEDULE FEE TYPES OF VEHICLES AND FEES SCHEDULE VEHICLES WITH AUTOMOBILE LICENSE PLATES Passenger vehicles and other vehicles with automobile plates UNLADEN unladen weight shown on the vehicle registration card or ownership certificate use fuel tax to vendors Sales tax applies to all purchases of LPG LNG or CNG even though the flat rate fuel tax has VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) More than 12 000 lbs VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) More than 4 000 lbs but less than 8 001 lbs VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) More than 8 000 lbs but less than 12 001 lbs VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) VEHICLES WITH COMMERCIAL PLATES (UNLADEN WEIGHT) 4 000 lbs or less 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 Winnebago Winnebago B YEAR 89 Winnebago C LICENSE NUMBER 2SAM123 Winnebago D UNLADEN WEIGHT Winnebago E TYPE OF FUEL LNG Winnebago F FEE $ 21 00 You may use this form to order decals for use fuel vehicles that you wish to add to your Annual Flat Rate Fuel Tax fleet You must have a current Annual Flat Rate Fuel Tax account with the State Board of Equalization (BOE) and your account must YOUR ACCOUNT NO

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