Free Certification as to use of Equipment - California

BOE-28REV.1(10-07)

STATEOFCALIFORNIA

CERTIFICATION AS TO USE OF EQUIPMENT

BOARDOFEQUALIZATION

This vehicle has not been operated or it has been in the possession of:
NAME TELEPHONENUMBER

(
ADDRESS(street, city, state, zip code)

)

For the period(s) of:
FROM TO

FROM

TO

And that the equipment (check whichever applies):
HASBEENSTORED HASBEENUSEDONPRIVATEPROPERTYEXCLUSIVELY HASBEENUSEDANDALLUSEFUELTAXESHAVEBEENPAIDBY (list below)
NAME USEFUELTAXPERMITNUMBER

Further, that (please check one):
NOTAXCLEARANCECERTIFICATECOVERINGTHISEQUIPMENTHASPREVIOUSLYBEENRECEIVED TAXCLEARANCECERTIFICATESPREVIOUSLYISSUEDARE(check one) ATTACHED UNAVAILABLE(If unavailable, please explain usage or disposition below.)

EXPLANATION

I hereby certify that the statements above are correct to the best of my knowledge and belief.
SIGNATURE TITLE

ADDRESS(street, city, state, zip code)



DATE

Mail completed form to Motor Carrier Section, MIC:65, State Board of Equalization, PO Box 942879, Sacramento, CA 94279-0065. If you have any questions regarding specific vehicle transfers, please telephone the Motor Carrier Section at 916-322-9669.
CLEAR PRINT