BOE-400-FEN (FRONT) (11-03)
STATE OF CALIFORNIA
APPLICATION FOR FUEL EXEMPTION NUMBER
BOARD OF EQUALIZATION
Read instructions on reverse before comleting this form.
SECTION I: OWNERSHIP AND BUSINESS INFORMATION
1. TYPE OF OWNERSHIP (check one) TAX IND
FOR BOARD USE ONLY
OFFICE ACCOUNT NUMBER
Sole Owner Corporation General Partnership Limited Partnership Other
Husband and Wife Limited Liability Company (LLC) Unincorporated Business Trust Limited Liability Partnership (LLP)
SJ
NAICS CODE BUS. CODE AREA CODE
85
PROCESSED BY CERTIFICATE ISSUE DATE (mm/dd/yy) REPORTING BASIS
X
STARTING DATE (mm/dd/yy)
2. NAME OF SOLE OWNER, HUSBAND AND WIFE, 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
Air Common Carrier
Water Common Carrier
7. BUSINESS ADDRESS (street, city, state/country, zip code)
8. MAILING ADDRESS (street, city, state/country, zip code, if different from business address)
SECTION II: AGENT INFORMATION
9. NAME OF AGENT IF APPLICABLE (submit copy of authorization with this application) 10. AGENT'S BUSINESS PHONE NUMBER
(
11. AGENT'S BUSINESS ADDRESS (street, city, state/country, zip code)
)
12. AGENT'S MAILING ADDRESS (street, city, state/country, zip code, if different from business address)
FILING INSTRUCTIONS
You will be required to file returns when (1) you are notified by the Board of Equalization to do so, or (2) when you incur a sales or use tax liability based on consumption of fuel erroneously claimed as exempt from sales or use tax at the time of purchase.
CERTIFICATION
I am am duly authorizedsign thisthis application and certify the statements made are correctthe the bestmy my knowledge and belief. I duly authorized to to sign application and certify the statements made are correct to to best of of knowledge and belief.
NAME (type or print) SIGNATURE
BUSINESS PHONE
TITLE
DATE (mm/dd/yy)
(
) FOR BOARD USE ONLY
FURNISHED TO TAXPAYER
BOE-519
REMARKS
Reg. 1621
Reg. 1667
Reg. 1702.5
Other
CLEAR
PRINT
BOE-400-FEN (BACK) (11-03)
INSTRUCTIONS
Section I Ownership and Business Information All Applicants:
(Items 1-8) You must provide the information requested for each type of owner. The purchasing carrier (vessel name, if applicable and if known) should be entered. The date fuel is first delivered to the vessel aircraft should also be entered.
Section II Agent Information:
(Items 9-12) If an agent is applying for the Fuel Exemption on behalf of the owner, the agent must submit a copy of the authorization at the time of application. All agent information is required.
Filing Instructions: If returns are required, the Board will send you information as stated. Certification: All applicants must sign this form. Authorized agents signing this form will be required to show proper identification.