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Form BOE-400-FEN Fillable Application for Fuel Exemption Number
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(Agents Business Address) (Agents Business Phone) (Agent's Email Address) (Agents Mailing Address) (Business Address) (Business Phonenumber) (CLEAR) CLEAR (DATE PURCHASES WILL BEGIN) (email Address) (Items 1 9) You must provide the information requested for each type of owner The purchasing (Items 10 14) If an agent is applying for the Fuel Exemption on behalf of the owner the agent must (Limited Partnership: Yes7) Unchecked (Limited Partnership: Yes8) Unchecked (Mailing Address) (Name of Agent) (NAME OF PURCHASING CARRIER) (NAME OF SOLE OWNER MARRIED CO OWNERSHIP REGISTERED DOMESTIC PARTNERSHIP CORPORATION LLP PARTNERSHIP OR TRUST) (name) (Other; other) (PRINT) PRINT (title) (todays date) 10 NAME OF AGENT IF APPLICABLE (submit copy of authorization with this application) 11 AGENT S BUSINESS PHONE NUMBER 12 AGENT S BUSINESS ADDRESS (street city state/country zip code) 13 AGENT S EMAIL ADDRESS 14 AGENT S MAILING ADDRESS (street city state/country zip code if different from business address) 2 NAME OF SOLE OWNER MARRIED CO OWNERSHIP REGISTERED DOMESTIC PARTNERSHIP CORPORATION LLP PARTNERSHIP OR TRUST 3 COUNTRY/STATE OF INCORPORATION OR ORGANIZATION 4 NAME OF PURCHASING CARRIER 5 DATE PURCHASES WILL BEGIN (mm/dd/yy) 6 NATURE OF BUSINESS 7 BUSINESS ADDRESS (street city state/country zip code) 8 EMAIL ADDRESS 9 MAILING ADDRESS (street city state/country zip code if different from business address) Air Common Carrier All applicants must sign this form Authorized agents signing this form will be required to show BOE 400 FEN (BACK) REV 1 (9 10) BOE 400 FEN (FRONT) REV 1 (9 10)STATE OF CALIFORNIAAPPLICATION FOR FUEL EXEMPTION NUMBERBOARD OF EQUALIZATIONRead instructions on reverse before completing this form BOE 519 carrier (vessel name if applicable and if known) should be entered The date fuel is first delivered to CERTIFICATION Certification: DATE (mm/dd/yy) FILING INSTRUCTIONS Filing Instructions: FOR BOE USE ONLY FOR BOE USE ONLYTAX IND OFFICE ACCOUNT NUMBERSJNAICS CODE BUS CODE AREA CODE85PROCESSED BY CERTIFICATE REPORTING BASISISSUE DATE(mm/dd/yy)XSTARTING DATE (mm/dd/yy) FURNISHED TO TAXPAYER General Partnership Unincorporated Business TrustLimited Partnership Limited Liability Partnership (LLP) I am duly authorized to sign this application and certify the statements made are correct to the best of my knowledge and belief If returns are required the BOE will send you information as stated If you are calling outside of the 48 contiguous states please call 916 445 6362 INSTRUCTIONS NAME (type or print) nearest you Unless otherwise noted all offices are open from 8:00 a m to 5:00 p m Monday Friday Pacific time except state holidays If you have any proper identification questions please call our Taxpayer Information Section at 800 400 7115 (TDD/TTY: 800 735 2929) Reg 1621 Reg 1667 Reg 1702 5 Other Registered Domestic PartnershipOther REMARKS Section I Ownership and Business Information All Applicants: SECTION I: OWNERSHIP AND BUSINESS INFORMATION1 TYPE OF OWNERSHIP (check one) Section II Agent Information: SECTION II: AGENT INFORMATION Send or take your application to the district officehttp://www boe ca gov/info/phone htm Send Your Application for Processing: SIGNATUREBUSINESS PHONE Sole Owner Married Co ownershipCorporation Limited Liability Company (LLC) submit a copy of the authorization at the time of application All agent information is required tax liability based on consumption of fuel erroneously claimed as exempt from sales or use tax at the time of purchase the vessel aircraft should also be entered TITLE Water Common Carrier You will be required to file returns when (1) you are notified by the Board of Equalization (BOE) to do so or (2) when you incur a sales or use