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Form BOE-231-PT Fillable Fuel Tax Exemption Certificate for Diesel Fuel and Motor Vehicle Fuel Train Operators
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(ADDRESS (street city state zip code) ) (BUSINESS ADDRESS (street city state zip code) ) (CALIFORNIA STATE BOARD OF EQUALIZATIONFUEL TAX EXEMPTION CERTIFICATEFOR DIESEL FUEL AND MOTOR VEHICLE FUELTRAIN OPERATORSSECTIONS 60106 AND 7403 REVENUE AND TAXATION CODE Questions on the completion or use of this form should be directed to the Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA 94279 0088 Telephone 800 400 7115 (TDD/TTY: 800 735 2929) CERTIFICATE NUMBER ) (CLEAR ) CLEAR (COMPANY NAME ) (EFFECTIVE DATE ) (EMAIL ADDRESS ) (FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) ) (FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) boe 231 pt rev/ 1 (10 10) ) (I the undersigned certify that to the best of my knowledge the information I have provided on this form is true and correct; that all diesel fuel and/or motor vehicle fuel purchased under this certificate is for operation of a train powered by diesel fuel or motor vehicle fuel as defined in Revenue and Taxation Code sections 60042 and 7342 or for other tax exempt use; and that I am the purchaser or authorized to sign this certificate as an agent of the purchaser By signing this certificate I acknowledge my understanding that if any diesel fuel or motor vehicle fuel purchased with this certificate is sold or otherwise used in a taxable manner I am required to report and pay the diesel fuel or motor vehicle fuel taxes on this fuel promptly at the time of sale or use I also understand that the law provides civil and criminal penalties for fraudulent use of this certificate PURCHASER NAME (print full name) ) (PRINT ) PRINT (SELLER NAME ) (SIGNATURE date ) (SUPPLIER LICENSE NUMBER ) (TITLE ) (TRAIN OPERATOR LICENSE NUMBER PT MT 05 ) 94279 0088 You may also visit the BOE website at www boe ca gov or ADDRESS (street city state zip code) and that I am the purchaser or authorized to sign this certificate as an agent of the purchaser BOE 231 PT REV 1 (10 10) BUSINESS ADDRESS (street city state zip code) By signing this certificate I acknowledge my understanding that if any diesel fuel or motor CALIFORNIA STATE BOARD OF EQUALIZATION call the Taxpayer Information Section at 800 400 7115 (TTY: 711); from CERTIFICATE NUMBER COMPANY NAME defined in Revenue and Taxation Code sections 60042 and 7342 or for other tax exempt use; EFFECTIVE DATE EMAIL ADDRESS Equalization Special Taxes and Fees P O Box 942879 Sacramento CA FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) fraudulent use of this certificate FUEL TAX EXEMPTION CERTIFICATEFOR DIESEL FUEL AND MOTOR VEHICLE FUELTRAIN OPERATORS I the undersigned certify that to the best of my knowledge the information I have provided If you need additional information please contact the State Board of on this form is true and correct; that all diesel fuel and/or motor vehicle fuel purchased under Pacific time except state holidays PURCHASER NAME (print full name) required to report and pay the diesel fuel or motor vehicle fuel taxes on this fuel promptly at SECTIONS 60106 AND 7403 REVENUE AND TAXATION CODE SELLER NAME service representatives are available weekdays from 8:00 a m to 5:00 p m SIGNATURE SUPPLIER LICENSE NUMBER the main menu select the option Special Taxes and Fees Customer the time of sale or use I also understand that the law provides civil and criminal penalties for this certificate is for operation of a train powered by diesel fuel or motor vehicle fuel as TITLE TRAIN OPERATOR LICENSE NUMBERPT MT 05 vehicle fuel purchased with this certificate is sold or otherwise used in a taxable manner I am