California Code of Regulations › Title 18 - Public Revenues › Division 2 - California Department of Tax and Fee Administration- Business Taxes (State Board of Equalization- Business Taxes, See Ch. 6 and 9.9) › Chapter 8.2 - Lead-Acid Battery Fees › Appendix A - General Exclusion and Exemption Certificate

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
California Exclusion and Exemption Certificate for
				  Lead-Acid Batteries
Not Subject to the Lead-Acid Battery
				  Fees
I HEREBY CERTIFY:
1. I hold a valid Seller's Permit or Certificate of
				  Registration -- Use Tax
[ ] Yes. Seller's Permit or Certificate of Registration. --
				  Use Tax number:
____________________________________________________________
[ ] No.
If you responded "No" to item number one, please complete
				  item number two.
2. Reason for not holding a Seller's Permit or Certificate of
				  Registration -- Use Tax:
____________________________________________________________
3. General description of the batteries covered by this
				  certificate:
____________________________________________________________
4. I am claiming an exclusion or exemption from the following
				  fee(s) (check all that apply):
[ ] California Battery Fee
[ ] Manufacturer Battery Fee
5. Each battery purchased is not subject to the lead-acid
				  battery fee(s) for one or more of the following reasons
[check all that apply]
[ ] Purchased for resale. (Only applies to the California
				  Battery Fee.)
[ ] A replacement lead-acid battery that will be temporarily
				  stored or used in California for the sole purpose of preparing the battery for
				  use solely outside of California and will be subsequently transported outside
				  the state and thereafter used solely outside of the state.
[ ] A battery to be incorporated into new equipment to be
				  resold with the battery.
[ ] A battery to be incorporated into a used vehicle sold or
				  leased by a new motor vehicle dealer. (Only applies to the California Battery
				  Fee)
[ ] A battery to be provided as a replacement, without
				  charge, under a vehicle or battery warranty or a vehicle service contract
				  described under Insurance Code section
				  12800.
[ ] A battery to be used with or contained within a medical
				  device, as defined in 21
				  U.S.C. 321(h).
[ ] A battery to be used as a stationary storage or standby
				  battery that is designed to be used in systems where the battery acts as
				  either: (Only applies to the California Battery Fee)
* Electrical storage for electricity generation
				  equipment;
* A source of emergency power; or
* Otherwise serves as a backup in case of failure or
				  interruption in the flow of power from the primary source.
6. I certify that the batteries I am purchasing under this
				  exclusion and exemption certificate are not subject to the lead-acid battery
				  fee(s) due to the exclusion(s) and/or exemption marked above and that the
				  lead-acid batteries will be used as certified. I understand that if any
				  lead-acid batteries are sold or used in a manner or for a purpose not specified
				  above, I am required to report and pay any applicable lead-acid battery fees,
				  including interest and penalties (if applicable), directly to the California
				  Department of Tax and Fee Administration.
NAME OF PURCHASER
SIGNATURE OF PURCHASER, PURCHASER'S EMPLOYEE
						  OR AUTHORIZED REPRESENTATIVE
PRINTED NAME OF PERSON SIGNING
TITLE
ADDRESS OF PURCHASER
TELEPHONE NUMBER
DATE
( )