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Form BOE-504-C1 Fillable Statement Concerning Property Purchased Without Payment of CA Sales Tax (Email Version)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(Address (street city state zip code)) (Auditor's Initials) (Comments) (Date) (Daytime Telephone Number Area Code) (Daytime Telephone Number) (DMA) (Email Address) (Email Name) (Fiscal Year) (Name of Business) (Name of Purchaser or Authorized Representative/Title) (Name of Seller from Whom You Purchased Items Without Sales Tax) (Quarter) (Row 1 Column 2 Invoice Number) (Row 1 Column 3 Purchase Order Number) (Row 1 Column 4 Amount) (Row 1 Column 5 Description) (Row 2 Column 2 Invoice Number) (Row 2 Column 3 Purchase Order Number) (Row 2 Column 4 Amount) (Row 2 Column 5 Description) (Row 3 Column 2 Invoice Number) (Row 3 Column 3 Purchase Order Number) (Row 3 Column 4 Amount) (Row 3 Column 5 Description) (Row 4 Column 2 Invoice Number) (Row 4 Column 3 Purchase Order Number) (Row 4 Column 4 Amount) (Row 4 Column 5 Description) (Row 5 Column 2 Invoice Number) (Row 5 Column 3 Purchase Order Number) (Row 5 Column 4 Amount) (Row 5 Column 5 Description) (Seller Permit Number of Purchaser (if applicable)) (Seller's Permit Number) (tax amount) @boe ca gov at the Board of Equalization (BOE) within 10 days In addition please include the seller s email address in the cc of your ADDRESS (street city state zip code) AMOUNT DESCRIPTION Auditor s Initials BOE 504 C1 REV 1 (10 11) STATE OF CALIFORNIA COMMENTS DATE INVOICE DAYTIME TELEPHONE NUMBER DMA DMA email NAME OF BUSINESS SELLER S PERMIT NUMBER OF PURCHASER (if applicable) EMAIL ADDRESS NAME OF PURCHASER OR AUTHORIZED REPRESENTATIVE/TITLE NAME OF SELLER FROM WHOM YOU PURCHASED ITEMS WITHOUT SALES TAX NUMBER ORDER Please check the appropriate box(es) below If none of these apply please explain below Please complete this form by providing the requested information Once completed please email the completed form to PURCHASE purpose other than retention demonstration or display while being held for sale in the regular course of business Quarter: Fiscal Year: retention demonstration or display while being held for sale in the regular course of business sales tax returns SELLER S PERMIT NUMBER STATEMENT CONCERNING PROPERTY PURCHASED BOARD OF EQUALIZATION tax in the amount of $ was added to the billing and remitted to the Seller tax in the amount of $ was paid directly to the BOE with our sales tax return for the reporting period The above property was purchased for leasing and tax measured by rental receipts has been paid directly to the BOE with our The above property was purchased for our own use and not for resale; and The above property was purchased for resale and is presently in resale inventory It has not been used for any purpose other than The above property was purchased for resale and was resold in the form of tangible personal property It was not used for any The information provided above is subject to verification by the Board of Equalization the purchase is a taxable transaction and tax is applicable WITHOUT PAYMENT OF CALIFORNIA SALES TAX