BOE-810-FTF (7-03)
STATE OF CALIFORNIA
GENERIC DISBURSEMENT SCHEDULE
(If additional space is needed, please photocopy the schedule before making entries.)
BOARD OF EQUALIZATION Page of
(e) MONTH/YEAR
(a) COMPANY NAME
(b) ACCOUNT NUMBER
(c) SCHEDULE CODE
(d) PRODUCT CODE
(1) CARRIER NAME
(2) CARRIER FEIN
(3) MODE
(4) POINT OF ORIGIN (TCN or State/Province) DESTINATION (TCN or State/Province)
(5) BUYER'S NAME
(6) BUYER'S FEIN
(7) DOCUMENT DATE
(8) DOCUMENT NUMBER
(9) NET GALLONS
(10) GROSS GALLONS
(11) BILLED GALLONS
TOTAL
CLEAR
PRINT