Free BOE-135-EFT (12-06) - California


File Size: 107.0 kB
Pages: 1
File Format: PDF
State: California
Category: Tax Forms
Author: nt4boe-work
Word Count: 180 Words, 1,124 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.boe.ca.gov/pdf/boe129eft.pdf

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BOE-129-EFT (3-07)

STATE OF CALIFORNIA

EFT TRANSMISSION DECLARATION

BOARD OF EQUALIZATION

INSTRUCTIONS: Please complete the entire form and return it to the Board of Equalization (Board) office that provided this form to you. Otherwise, you may mail the completed form to your local Board office listed in the telephone directory under State Government, or as listed on our website at www.boe.ca.gov. Upon receipt of the completed form, the Board will review it and you will be notified by mail of the decision.

NAME OF TAXPAYER/FEEPAYER

ACCOUNT NUMBER

REPORTING PERIOD

I,

print name

, state that at approximately

time

circle one

a.m./p.m. on the

date

day of

month and year

I initiated an Electronic Funds Transfer to the State Board of Equalization as follows: Internet Method Touch Tone Telephone Voice Operator Payment amount : Debit date selected (if any): Reference Number Received:

Explanation:

CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
SIGNATURE TITLE DATE

PRINTED NAME

TELEPHONE NUMBER

(

)