Internet Method
month and year
state that at approximately
time circle one
Touch Tone Telephone
Voice Operator
a m /p m on the
ACCOUNT NUMBER
BOE 129 EFT (3 07) STATE OF CALIFORNIA
CERTIFICATION
day of
Debit date selected (if any):
EFT TRANSMISSION DECLARATION BOARD OF EQUALIZATION
Explanation:
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct
I initiated an Electronic Funds Transfer to the State Board of Equalization as follows:
INSTRUCTIONS: Please complete the entire form and return it to the Board of Equalization (Board) office
listed in the telephone directory under State Government or as listed on our website at www boe ca gov
NAME OF TAXPAYER/FEEPAYER
Payment amount:
print name
PRINTED NAME
Reference Number Received:
REPORTING PERIOD
SIGNATURE
TELEPHONE NUMBER
that provided this form to you Otherwise you may mail the completed form to your local Board office
TITLE
Upon receipt of the completed form the Board will review it and you will be notified by mail of the decision
