BOE-555-LJ (FRONT) REV. 1(10-02) …

BOE-555-LJ (FRONT) REV. 1(10-02)                                                                                                  STATE OF CALIFORNIA
EFT AUTHORIZATION AGREEMENT FOR LOCAL JURISDICTIONS                                                                     BOARD OF EQUALIZATION




 Please type or print clearly in ink.
 See reverse for complete instructions.

         SELECT ACTION REQUESTED                                                              SELECT TAX PROGRAM
    New EFT Account                                                                         1% Local Tax
    Change EFT Bank Account ­ (see instructions)                                            ¼% (County) Transportation Fund
    Cancel EFT                                                                              Add-on (Special District) Tax

SECTION I
NAME OF LOCAL JURISDICTION OR SPECIAL DISTRICT (payee)                                                  TAX AREA CODE


CONTACT PERSON (name and title)                                                                                 CONTACT PHONE NUMBER



MAILING ADDRESS                                                                      CITY, STATE, ZIP



SECTION II
The State Controller's Office, on behalf of the State Board of Equalization, is hereby authorized to make direct deposit (EFT)
of any amounts distributed pursuant to the Bradley-Burns Uniform Local Sales and Use Tax Law or the Transactions and Use
Tax Law less any mandatory withholding or deductions therefrom to the designated bank account identified below. If the
designated EFT account is a checking account, a voided check or copy must be attached to the completed authoriza-
tion agreement. If the account is a savings or other deposit-only account, an account confirmation from the bank must
be attached. The voided check or confirmation will be used to verify the bank account and transit routing numbers.
BANK NAME



BANK ACCOUNT NUMBER (not to exceed 17 digits)



TRANSIT ROUTING NUMBER



TYPE OF ACCOUNT

    CHECKING                      SAVINGS

                                                                         IMPORTANT
Payee agrees that in the event that the payee owes a debt determined either by court order, or otherwise by operation of
law, and for which the Board has been notified according to law, to make repayments by deductions from Local Sales and
Use Tax transmittals, the payee will be removed from the EFT program until the debt is extinguished.

SIGNATURE                                                        TITLE                                          DATE




                                                                Return this form to:
                                                    (Hard Copy with Original Signature Required)
                                                                 Board of Equalization
                                                           Local Revenue Allocation Section
                                                               P.O. Box 942879, MIC:27
                                                             Sacramento, CA 94279-0027
                                                                  FAX 916-324-8117
                                                         For EFT assistance call 916-324-1386

                                                This information is confidential and not for public release.
BOE-555-LJ (BACK) REV. 1 (10-02)




                                      INSTRUCTIONS FOR LOCAL JURISDICTIONS FOR
                                   COMPLETING THE EFT AUTHORIZATION AGREEMENT FORM

GENERAL
 Read this agreement carefully, and if you have questions call 916-324-1386.
 Please type or print clearly.
 Check one action box and one tax program box. Your jurisdiction's tax program can be found on the title line of the
 remittance advice received from the State Controller's Office.
 Complete all information blocks.

SECTION I
 Your jurisdiction's tax area code can be found on the remittance advice immediately above the word "Payee."
 A contact person and telephone number are required to process your authorization agreement.

SECTION II
 The "Transit Routing Number" (nine digits) typically can be found in the bottom left-hand corner of your check.
 Please indicate the type of account. (Checking or Savings)
 Be sure to include a voided check or bank confirmation with your authorization agreement.

ADDITIONAL INFORMATION
 Changing EFT Bank Account
     ·    IMPORTANT: DO NOT CLOSE YOUR OLD ACCOUNT UNTIL THE FIRST EFT PAYMENT IS DEPOSITED INTO
          THE NEWLY DESIGNATED ACCOUNT.
     ·    This agreement will remain in effect until the Board of Equalization is notified in writing that you wish to
          redesignate your account and/or your financial institution, or that you wish to cancel EFT service.
     ·    To redesignate, please submit a new EFT Authorization Agreement for Local Jurisdictions. Be sure to
          check the correct action box on the front of the form, and provide the correct new information.
     ·    The first deposit into a new account should be made within 60 days from the Board's receipt of the
          completed EFT Authorization Agreement.
     ·    In the interim between the closing of the old account and opening of the new account, you may receive
          a warrant via U.S. Mail.

 Canceling EFT Service
 · To cancel EFT service, submit a new EFT Authorization Agreement for Local Jurisdictions, and check the
    "CANCEL EFT" box. Be sure to complete all information blocks.

 EFT Direct Deposit Posting Dates
     ·    Funds will be deposited on the "Warrant Issue Date" as shown on the Board's Allocation Calendar. Calendars can
          be found in Publication 28, Tax Information for City and County Officials, downloaded from the Board's website
          at www.boe.ca.gov/pdf/pub28.pdf (see exhibits), or requested from the Local Revenue Allocation Section at
          916-324-3000.
     ·    Most financial institutions post funds to accounts at the beginning of the bank business day; however, you should
          confirm your particular bank's practice to determine when funds will be available.

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