Free Train Operator Information Report - California

BOE-506-PT (S1) REV. 1 (4-03)

BOARD OF EQUALIZATION
BOARD USE ONLY
RA-B/A RR-QS AUD FILE REG REF

STATE OF CALIFORNIA

TRAIN OPERATOR INFORMATION REPORT DUE ON OR BEFORE

[ FOID

]

YOUR ACCOUNT NO. EFF

BOARD OF EQUALIZATION FUEL TAXES DIVISION PO BOX 942879 SACRAMENTO CA 94279-2074
READ INSTRUCTIONS BEFORE PREPARING

As a train operator in California, you are required to report all exempt purchases of undyed diesel fuel, dyed diesel fuel and motor vehicle fuel for use in this state to the Board of Equalization (Board).

PRODUCT

GALLONS

1. Total gallons of ex-tax undyed diesel fuel purchased for use in this state (enter gallons from Schedule TO for all undyed diesel product codes). 2. Total gallons of dyed diesel fuel purchased for use in this state (enter gallons from Schedule TO for all dyed diesel product codes). 3. Total gallons of ex-tax motor vehicle fuel purchased for use in this state (enter gallons from Schedule TO for motor vehicle fuel).

1.

2.

3.

CERTIFICATION

I hereby consent to disclosure and authorize the Board to release, as necessary, certain otherwise confidential transaction information regarding volumes, invoice numbers, bills of lading, locations, dates, or method of delivery of reportable products to any person identified by me in this report as being involved in a reported transaction for the sole purpose of verifying the accuracy of the reportable product transaction information concerning my transactions with such person as reported in this report. I hereby certify that this report, including any accompanying schedules and statements, have been examined by me and to the best of my knowledge and belief is a true, correct, and complete report.

YOUR SIGNATURE AND TITLE

TELEPHONE NUMBER

DATE

Make a copy of this document and the accompanying schedules for your records.

BOE-506-PT (S3) REV. 1 (4-03)

STATE OF CALIFORNIA

BOARD OF EQUALIZATION

RECEIPT SCHEDULE TO - TRAIN OPERATOR
(If additional space is needed, please photocopy the schedule before making entries.) (a) COMPANY NAME (b) ACCOUNT NUMBER (c) PRODUCT CODE

Page

of

(d) MONTH/YEAR

(1) CARRIER NAME

(2) CARRIER FEIN

(3) MODE

(TCN or State/Province)

(4) POINT OF ORIGIN DESTINATION
(TCN or State/Province)

(5) ACQUIRED FROM (SELLER'S NAME)

(6) SELLER'S FEIN

(7) DOCUMENT DATE

(8) DOCUMENT NUMBER

(9) NET GALLONS

(10) GROSS GALLONS

(11) BILLED GALLONS

TOTAL
CLEAR PRINT