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Form BOE-126 Fillable You May Qualify for an Installment Payment Agreement
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(: bi monthly) Unchecked (: bi weekly) Unchecked (: monthly) Unchecked (: weekly) Unchecked (check one) (clear) CLEAR (Consumer use tax aCCount) (Date) (daytime phone number (Area code)) (daytime phone number) (Driver License Number) (Names updated 2012) (Print name as shown on tax return) (PRINT) PRINT (ProPosed Payment amount) (text) 450 N Street and provide other documents These documents will be reviewed to determine if you qualify and your ability to pay You may need to complete BOE 403 E Individual Financial Statement Auto Pay With Auto Pay we will automatically debit your checking or savings account for BETTY T YEEFirst DistrictSan FranciscoSEN GEORGE RUNNER (Ret ) Bi Weekly BOARD MEMBERS Board of Equalization Logo BOE 126 REV 4 (12 08) California 95814 completed tax return (if not previously filed) and a payment in the amount of your proposed Consumer use tax aCCount CYNTHIA BRIDGES daytime Phone number driver LiCense number Executive Director for an agreement for an Installment Payment Agreement For more information contact the Centralized Collection Section at 916 445 3670 or visit our If you wish to propose an agreement please complete the section below Send this form your If your proposal is accepted you will be required to make your installment payments using installment payment in the enclosed return envelope Continue to send your proposed payments installments The amount of your installment payments will depend on the amount you owe may cost you more than if you pay the entire balance by borrowing the money from a third may pay your liability in weekly bi weekly (every other week) monthly or twice monthly money order Monthly OF EQUALIZATION party Additionally a state tax lien may be recorded even if you enter into an agreement payments by applying for an installment payment agreement (agreement) If you qualify you payments required by your agreement An Auto Pay authorization form and details regarding Print name as shown on tax return ProPosed Payment amount Sacramento Second DistrictLancasterMICHELLE STEELThird DistrictOrange CountyJEROME E HORTONFourth DistrictLos AngelesJOHN CHIANG signature Signature Hand Since interest and penalties accrue on any unpaid tax amount until paid in full an agreement soCiaL seCurity number (see BOE 324 GEN for SSN disclosure information) STATE BOARD State Controller this program will be provided with your agreement Twice Monthly until we notify you otherwise Please write your account number on your check or website at www boe ca gov Weekly You may be eligible to pay your Consumer Use Tax liability in smaller and more manageable Your Consumer Use Tax Account May Qualify