Form BOE-506-PT Fillable Train Operator Information Report

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((a) COMPANY NAME) ((b) ACCOUNT NUMBER) ((c) PRODUCT CODE) ((d) MONTH/YEAR) (1) (2) (3) (5) (6) (7) (8) (9) (10) (11) (a) COMPANY NAME (B O E USE ONLY) (b) ACCOUNT NUMBER (button) CLEAR (button) PRINT (c) PRODUCT CODE (Column (10) GROSS GALLONS TOTAL) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (10) GROSS GALLONS) (Column (11) BILLED GALLONS TOTAL) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (11) BILLED GALLONS) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (2) CARRIER FEIN) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (3) MODE) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF DESTINATION (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (4) POINT OF ORIGIN (TCN or State/Province)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (5) ACQUIRED FROM (SELLER'S NAME)) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (6) SELLER'S FEIN) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (7) DOCUMENT DATE) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (8) DOCUMENT NUMBER) (Column (9) NET GALLONS TOTAL) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column (9) NET GALLONS) (Column 3 MODE) (d) MONTH/YEAR (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (Page) (PRINT NAME AND TITLE) (PRODUCT 1 Total gallons of ex tax undyed diesel fuel purchased for use in this state (enter gallons from Schedule TO for all undyed diesel product codes) GALLONS 1 ) (PRODUCT 2 Total gallons of dyed diesel fuel purchased for usein this state (enter gallons from Schedule TO for all dyed diesel product codes) GALLONS 2 ) (PRODUCT 3 Total gallons of ex tax motor vehicle fuelpurchased for use in this state (enter gallons from Schedule TO for motor vehicle fuel) GALLONS 3 ) (Row 1 Column 1 (1) CARRIER NAME) (Row 10 Column (1) CARRIER NAME) (Row 11 Column (1) CARRIER NAME) (Row 12 Column (1) CARRIER NAME) (Row 13 Column (1) CARRIER NAME) (Row 14 Column (1) CARRIER NAME) (Row 15 Column (1) CARRIER NAME) (Row 16 Column (1) CARRIER NAME) (Row 17 Column (1) CARRIER NAME) (Row 18 Column (1) CARRIER NAME) (Row 19 Column (1) CARRIER NAME) (Row 2 Column (1) CARRIER NAME) (Row 20 Column (1) CARRIER NAME) (Row 21 Column (1) CARRIER NAME) (Row 3 Column (1) CARRIER NAME) (Row 4 Column (1) CARRIER NAME) (Row 5 Column (1) CARRIER NAME) (Row 6 Column (1) CARRIER NAME) (Row 7 Column (1) CARRIER NAME) (Row 8 Column (1) CARRIER NAME) (Row 9 Column (1) CARRIER NAME) (S2B) (TELEPHONE AREA CODE ()) (TELEPHONE) (text) (YOUR ACCOUNT NO ) [ FOID] 2 Total gallons of dyed diesel fuel purchased for usein this state (enter gallons from Schedule TO for alldyed diesel product codes) 3 Total gallons of ex tax motor vehicle fuelpurchased for use in this state (enter gallons fromSchedule TO for motor vehicle fuel) 800 400 7115 (TTY: 711); from the main menu select the option Special Taxes and Fees A receipt schedule must be included with every Train Operator Information Report Report one product code per page for As a train operator in California you are required to report all exempt purchases of undyed diesel fuel dyed diesel BOARD OF EQUALIZATION BOARD OF EQUALIZATION BOE 506 PT (S1) REV 2 (3 11) BOE 506 PT (S2B) REV 2 (3 11) BOE 506 PT (S2F) REV 2 (3 11) STATE OF CALIFORNIA BOE 506 PT (S3) REV 2 (3 11) STATE OF CALIFORNIA CERTIFICATION Column 1 Enter the name of the carrier that transported the product Column 10 Enter the gross gallons for the transaction Column 11 Enter the billed gallons for the transaction Column 2 Enter the carrier's FEIN (Federal Employer Identification Number) Column 3 Enter the mode of transportation from the mode codes list Column 4 Enter the point of origin/point of destination (enter the IRS terminal control number (TCN) If the product is Column 5 Enter the seller's name Column 6 Enter the seller's FEIN Column 7 Enter the date from the bill of lading shipping document or manifest (enter as mm/dd/yy) Column 8 Enter the identifying number from the document provided that reflects the details of this transaction This Column 9 Enter the net gallons for the transaction complete listing of all product codes can be viewed at the following website location: concerning my transactions with such person as reported in this report could be a bill of lading shipping document or manifest Both the train operator and the terminal operator delivery of reportable products to any person identified by me in this report as being involved in a reported DUE ON OR BEFORE EMAIL ADDRESS Every train operator is required to report the total number of gallons of undyed diesel fuel dyed diesel fuel and motor filed with the BOE on or before the last day of the calendar month following the quarterly period shown on the face of the FILING REQUIREMENTS for use in this state as a train operator fuel and motor vehicle fuel for use in this state to the State Board of Equalization (BOE) GENERAL INFORMATION header of the schedule Boxes (a) Company Name (b) Account Number and (d) Month/Year will be completed for you http://www boe ca gov/sptaxprog/spftdmfuels htm For each Schedule TO complete the information in box (c) in the I hereby certify that this report including any accompanying schedules and statements have been examined by I hereby consent to disclosure and authorize the BOE to release as necessary certain otherwise confidential If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 include all of the page totals for any undyed diesel fuel product code types INSTRUCTIONS Line 1 Enter the total gallons of ex tax undyed diesel fuel purchased from Schedule TO This total will Line 2 Enter the total gallons of dyed diesel fuel purchased from Schedule TO This total will include all of Line 3 Enter the total gallons of ex tax motor vehicle fuel purchased from Schedule TO Make a copy of this document and the accompanying schedules for your records me and to the best of my knowledge and belief is a true correct and complete report MODE Barge MODE CODE B MODE CODE J MODE CODE PL MODE CODE R MODE CODE S MODE CODES MODE MODE CODE MODE Truck MODE Pipeline MODE Rail MODE Ship (ocean marine vessel) motor vehicle fuel products for use in this state must report the same document number to the BOE NAME FEIN (TCN or (TCN or (SELLER'S NAME) FEIN DATE NUMBER GALLONS GALLONS GALLONS not received from a terminal enter the two character U S Postal Service abbreviation for the state of ORIGIN DESTINATION origin Obtain from the Postal Abbreviations list available on our website) page for the period If additional space is needed please photocopy the schedule before making any entries Page of PO BOX 942879 POINT OF CARRIER CARRIER MODE ACQUIRED FROM SELLER'S DOCUMENT DOCUMENT NET GROSS BILLED Preparation of Schedule TO PREPARATION OF THE REPORT PRINT NAME AND TITLE PRODUCTGALLONS1 Total gallons of ex tax undyed diesel fuel purchased for use in this state (enter gallons from purchases of reportable fuel must also be completed The Train Operator Information Report and Schedule TO must be READ INSTRUCTIONSBEFORE PREPARING RECEIPT SCHEDULE TO TRAIN OPERATOR (If additional space is needed please photocopy the schedule before making entries ) report No remittance is due with this report Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at SACRAMENTO CA 94279 2074 Schedule TO for all undyed diesel product codes) Schedule TO Train Operator Receipt Schedule SIGNATURE SPECIAL TAXES AND FEES STATE OF CALIFORNIABOARD OF EQUALIZATION State/Province) State/Province) TELEPHONE( the page totals for any dyed diesel fuel product code types the period (Photocopy additional pages as required to report only one product code per page ) As mentioned above a The Train Operator Information Report allows California train operators to report their purchases of exempt diesel fuel and This report includes a supporting receipt schedule (Schedule TO) This receipt schedule is used to report each receipt of To obtain the latest information on any product codes or if you need help completing this form please visit the BOE's TOTAL TRAIN OPERATOR INFORMATION REPORT transaction for the sole purpose of verifying the accuracy of the reportable product transaction information transaction information regarding volumes invoice numbers bills of lading locations dates or method of undyed diesel fuel dyed diesel fuel and motor vehicle fuel (gasoline) There can be only one product type reported per Use Schedule TO to report all receipts of undyed diesel fuel dyed diesel fuel and motor vehicle fuel that were purchased vehicle fuel purchased tax exempt for use in this state Receipt Schedule (Schedule TO) which details all of your ex tax website at: http://www boe ca gov/sptaxprog/spftdmfuels htm or contact us at the number listed at the bottom of page YOUR ACCOUNT NO

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