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Form BOE-555-LJ Fillable EFT Authorization Agreement for Local Jurisdictions
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)CANCEL EFT box Be sure to complete all information blocks Funds will be deposited on the Warrant Issue Date as shown on the BOE s Allocation Calendar Calendars Most financial institutions post funds to accounts at the beginning of the bank business day; however you Please type or print clearly in ink See reverse for complete instructions (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK ACCOUNT NUMBER (not to exceed 17 digits) (BANK NAME) (CITY STATE ZIP) (CLEAR BUTTON) CLEAR (CONTACT FAX NUMBER) (CONTACT PERSON (name and title)) (CONTACT PHONE NUMBER) (DATE) (EMAIL ADDRESS) (MAILING ADDRESS) (NAME OF LOCAL JURISDICTION OR SPECIAL DISTRICT (payee)) (PRINT BUTTON) PRINT (TAX AREA CODE) (TITLE) (Transit Routing NO) (Transit Routing NO) (Transit Routing NO) (Transit Routing NO) (Transit Routing NO) A contact person and telephone number are required to process your authorization agreement ADDITIONAL INFORMATION and/or your financial institution or that you wish to cancel EFT service at 916 324 3000 BANK ACCOUNT NUMBER (not to exceed 17 digits) BANK NAME Be sure to include a voided check or bank confirmation with your authorization agreement Board of Equalization BOE 555 LJ (BACK) REV 2 (1 12) BOE 555 LJ (FRONT) REV 2 (1 12)STATE OF CALIFORNIA can be found in Publication 28 Tax Information for City and County Officials downloaded from the BOE s Canceling EFT Service Changing EFT Bank Account Check one action box and one tax program box Your jurisdiction s tax program can be found on the title line of the CHECKING SAVINGS CITY STATE ZIP Complete all information blocks completed authorization agreement If the account is a savings or other deposit only account an account confirmation CONTACT FAX NUMBER CONTACT PERSON (name and title) CONTACT PHONE NUMBER correct action box on the front of the form and provide the correct new information deposit (EFT) of any amounts distributed pursuant to the Bradley Burns Uniform Local Sales and Use Tax Law or the EFT Authorization Agreement EFT AUTHORIZATION AGREEMENT FOR LOCAL JURISDICTIONSBOARD OF EQUALIZATION EFT Direct Deposit Posting Dates EMAIL ADDRESS from the bank must be attached The voided check or confirmation will be used to verify the bank account and transit GENERAL I affirm that deposits received from the BOE are not subject to being transferred to a foreign financial institution identified below If the designated EFT account is a checking account a voided check or copy must be attached to the IMPORTANT IMPORTANT: DO NOT CLOSE YOUR OLD ACCOUNT UNTIL THE FIRST EFT PAYMENT IS DEPOSITED In the interim between the closing of the old account and opening of the new account you may receive a INSTRUCTIONS FOR LOCAL JURISDICTIONS FORCOMPLETING THE EFT AUTHORIZATION AGREEMENT FORM INTO THE NEWLY DESIGNATED ACCOUNT law and for which the BOE has been notified according to law to make repayments by deductions from Local Sales and Local Revenue Allocation Unit MAILING ADDRESS NAME OF LOCAL JURISDICTION OR SPECIAL DISTRICT (payee) P O Box 942879 MIC:27 Payee agrees that in the event that the payee owes a debt determined either by court order or otherwise by operation of Please indicate the type of account (Checking or Savings) Please type or print clearly Read this agreement carefully and if you have questions call 916 324 1386 remittance advice received from the State Controller s Office Return this form to: routing numbers Sacramento CA 94279 0027FAX 916 324 8117For EFT assistance call 916 324 1386 SECTION I SECTION II SELECT ACTION REQUESTEDSELECT TAX PROGRAMNew EFT Account 1% Local TaxChange EFT Bank Account (see instructions) % (County) Transportation FundCancel EFT Add on (Special District) Tax should confirm your particular bank s practice to determine when funds will be available SIGNATURETITLE DATE TAX AREA CODE The first deposit into a new account should be made within 60 days from the BOE s receipt of the completed The State Controller s Office on behalf of the State Board of Equalization (BOE) is hereby authorized to make direct The Transit Routing Number (nine digits) typically can be found in the bottom left hand corner of your check This agreement will remain in effect until the BOE is notified in writing that you wish to redesignate your account This information is confidential and not for public release To cancel EFT service submit a new EFT Authorization Agreement for Local Jurisdictions and check the To redesignate please submit a new EFT Authorization Agreement for Local Jurisdictions Be sure to check the Transactions and Use Tax Law less any mandatory withholding or deductions therefrom to the designated bank account TRANSIT ROUTING NUMBERTYPE OF ACCOUNT Use Tax transmittals the payee will be removed from the EFT program until the debt is extinguished Warrant Desk warrant via U S Mail website at www boe ca gov/pdf/pub28 pdf (see exhibits) or requested from the Local Revenue Allocation Unit Your jurisdiction s tax area code can be found on the remittance advice immediately above the word Payee