BOE-231 (FRONT) REV. 3 (4-99)
STATE OF CALIFORNIA
APPLICATION FOR SECTION 6377 MANUFACTURER'S EXEMPTION CERTIFICATE AND USE TAX DECLARATION
Please type or print. Attach additional sheets as needed. See reverse for instructions.
SECTION I: OWNERSHIP INFORMATION
1. OWNER 2. DBA
BOARD OF EQUALIZATION
3. CA SALES/USE TAX PERMIT NO.
4. SIC CODE
5. BUSINESS LOCATION (street, city, state and zip code)
6. BUSINESS TELEPHONE NUMBER
7. MAILING ADDRESS (street, city, state and zip code)
8. NAME AND CAPACITY OF REPRESENTATIVE
9. TYPE OF OWNERSHIP 10. DATE FORMED OR ORGANIZED 11. FEIN
12. CORPORATE NUMBER
SECTION II: PARTNERS/STOCKHOLDERS/MANAGER/MEMBERS (This section applies only to a partnership, corporation or LLC.)
13. NAME 14. SOCIAL SECURITY NO. 15. % OF OWNERSHIP
Have any of the persons or entities listed in Section II been engaged in another manufacturing business in California, as a sole proprietor, partner, stockholder, or member? Yes No If yes, attach a separate sheet and list the name of that business, sales/use tax permit, and same information as required in Section II.
SECTION III: BUSINESS ACTIVITIES
16. MANUFACTURING LOCATIONS (name, street, city and state)
17. MANUFACTURING OPERATIONS AND FINISHED PRODUCTS
18. DATE YOU FIRST CONDUCTED OR WILL CONDUCT A BUSINESS ACTIVITY RELATED TO MANUFACTURING IN CALIFORNIA
19. ACTIVITIES BETWEEN THE DATES IN BOX 10 AND BOX 18
20.DATE OF FIRST PURCHASE OF MANUFACTURING EQUIPMENT IN CALIFORNIA
21. DATE OF INCEPTION OF FIRST LEASE OF MANUFACTURING EQUIPMENT IN CALIFORNIA
22. DATE YOU FIRST BEGAN OR WILL BEGIN PRODUCTION IN CALIFORNIA
23. ARE YOU CURRENTLY ENGAGED IN A BUSINESS OTHER THAN MANUFACTURING?
No If yes, describe such business activities
Yes No If yes, complete Box 25 through 27.
26. CA SALES/USE TAX PERMIT NO. 27. TYPE OF BUSINESS AND SIC CODE
24. Have you previously been engaged in a trade or business in California?
SECTION IV: PURCHASE OF EXISTING BUSINESS (Complete this section only if you have purchased or will purchase an existing business in state).
28. NAME AND CALIFORNIA SALES/USE TAX PERMIT NUMBER OF SELLER STOCK PURCHASE ONLY 29. TOTAL PURCHASE PRICE 30. PURCHASE DATE
31. Are you engaged in a business, inside or outside California, other than this acquisition?
32. NAME AND LOCATION OF OTHER BUSINESS 33. TYPE OF BUSINESS
No If yes, complete box 32 through 35 for each business.
34. FAIR MARKET VALUE OF TOTAL ASSETS 35. VALUATION DATE
$ SECTION V: CHANGE IN LEGAL FORM (Complete this section only if the business entity in this application is a result of a change in legal form).
36. NAME AND CALIFORNIA SALES/USE TAX PERMIT NUMBER OF PREVIOUS ENTITY 37. OWNERS OF THE PREVIOUS ENTITY
38. DATE LEGAL FORM WAS CHANGED 39. TYPE OF OWNERSHIP OF PREVIOUS ENTITY
% OF OWNERSHIP
The statements above are hereby certified to be correct to the best knowledge and belief of the undersigned, who is duly knowledge and belief of the undersigned, who is duly The statements above are hereby certified to be correct to authorized sign this application. (If not a sole proprietor, partner, corporate officer or manage/member of LLC, please authorized to to sign this application. (If not a soleproprietor, partner, corporate officer or manager/member of LLC, please complete and attach BOE-392, Power of Attorney.) complete and attach BOE-392, Power of Attorney.)
40. PRINT NAME 41. CAPACITY
BOE-231 (BACK) REV. 3 (4-99)
Box 1: Box 2: Box 3: Enter the name of sole proprietor, husband/wife, partnership, corporation, or Limited Liability Company (LLC). Enter the name you are otherwise known as ("doing business as"). Enter your seller's permit or consumer use tax permit number. This application will not be processed without a permit number. If you are required to hold a sales/use tax permit, and you do not have one, call (800) 400-7115 to obtain an application. Submit your application for manufacturer's partial exemption when you receive your permit number from the Board of Equalization. Enter the code in which your business is classified in the 1987 Edition of the Standard Industrial Classification Manual (SIC). If you do not know what your code is, you may leave this blank. The Board will determine your code based on available information. Enter the address where you conduct your business. Enter the telephone number for your business location. Enter the address where you receive mail if different from box 5. Enter the name and capacity of the person authorized to communicate with the Board regarding this application (for example: John Doe, CPA). Enter this person's daytime telephone and fax numbers. If you are a sole owner and you represent yourself, enter "owner" and your daytime telephone and fax numbers. Enter the type of business entity (Sole Proprietor, Husband/Wife, Partnership, Corporation or LLC). Enter the date this business entity was first formed or organized. Enter you Federal Employer Identification Number (FEIN). If corporation or LLC, enter the number the Secretary of State has stamped on the Articles of Incorporation. Enter the name of ALL partners and LLC members, regardless of % of ownership. Enter the name of stockholders owning 50% or more of stocks. If none of the stockholders own at least 50%, enter "NONE" and skip to box 16. Enter the social security number of each person listed in box 13. Enter the percentage of ownership for each person listed in box 13. Enter the name and address of the location(s) where manufacturing is or will be performed. Describe your manufacturing operations and list the products that are or will be manufactured. This date commences your manufacturing trade or business. This date could be on or before the date you first purchased or leased manufacturing equipment. Research and development activities alone do not commence manufacturing activities. Describe business activities after the business entity was formed (box 10) until manufacturing-related activities commenced (box 18). Enter the date you first purchased or will purchase manufacturing equipment. Box 40: Box 41: Box 42: Box 43: Box 37: Box 38: Box 39: Box 32: Box 33: Box 34: Box 35: Box 36: Box 29: Box 30: Box 31: Box 21: Box 22: Box 23: Enter the date you first leased or will lease manufacturing equipment. Enter the date you began production or the estimated start date of production. If you conduct business activities other than manufacturing and selling the products you manufacture as described in box 17, describe such other activities. If you operated a prior business, mark "yes" and complete box 25. If you do not have a prior business, mark "no" and skip to box 40 if sections IV or V do not apply to you. Enter the name of prior business. Complete box 26. Enter seller's permit or consumer use tax permit number of prior business. Complete box 27. Describe activities of prior business and the SIC code for that business. Enter the name and the permit number of the business acquired or will be acquired. Mark box if you purchased shares of stocks only. Enter the total purchase price of the business acquired or will be acquired. Enter the date of acquisition. If you are currently engaged in a business other than this acquisition, or you have other acquisitions mark "yes". If "no" skip to box 40 if section V does not apply. If "yes" in box 31, enter the name and address (City & State) of each business entity. Describe business activities of each entity listed in box 32. Enter the fair market value of total assets of each business entity listed in box 32. Enter the date the fair market value listed in box 34 was determined. Enter the name and permit number of the business entity under which you previously operated. Enter the name of the sole proprietor, partners, stockholders, or members of the previous entity and their % of ownership. Enter the effective date of the change. Enter the type of business organization (sole proprietorship, husband/wife, partnership, corporation or LLC) of the previous entity. Print or type the name of the individual authorized to sign this application. Enter capacity of the individual named in box 40. Attach a Power of Attorney as required. Signature of the individual named in box 40. Signature must be original. Enter date this application was signed.
Box 25: Box 26: Box 27: Box 28:
Box 5: Box 6: Box 7: Box 8:
Box 9: Box 10: Box 11: Box 12: Box 13:
Box 14: Box 15: Box 16: Box 17: Box 18:
FOR BOARD USE ONLY
Three-Year Period Begins
DATE CERTIFICATE/DECLARATION ISSUED
REASON FOR DENIAL
DATE OF DENIAL LETTER