Form BOE-240-A Fillable Distilled Spirits Received from Own Bottling Plant

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(BOE 240 A (Front) REV 2 (10 10) STATE OF CALIFORNIA DISTILLED SPIRITS RECEIVED FROM OWN BOTTLING DEPARTMENT BOARD OF EQUALIZATION ACCOUN T NUMBER Please read the instructions on the reverse before preparing this report ) (BUSINESS ADDRESS street city state and ZIP code ) (CLEAR) CLEAR (COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER TOTALS ) (COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER Totals from previous page ) (COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF TOTALS ) (COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF Totals from previous page ) (DATE ) (FOR MONTH OF ) (NAME ) (of Pages ; Page) (Page) (PRINT) PRINT (ROW 1 COLUMN A DATE ) (ROW 1 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 1 COLUMN C ADDRESS ) (ROW 1 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 1 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 10 COLUMN A DATE ) (ROW 10 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 10 COLUMN C ADDRESS ) (ROW 10 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 10 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 11 COLUMN A DATE ) (ROW 11 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 11 COLUMN C ADDRESS ) (ROW 11 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 11 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 12 COLUMN A DATE ) (ROW 12 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 12 COLUMN C ADDRESS ) (ROW 12 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 12 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 13 COLUMN A DATE ) (ROW 13 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 13 COLUMN C ADDRESS ) (ROW 13 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 13 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 14 COLUMN A DATE ) (ROW 14 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 14 COLUMN C ADDRESS ) (ROW 14 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 14 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 15 COLUMN A DATE ) (ROW 15 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 15 COLUMN C ADDRESS ) (ROW 15 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 15 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 16 COLUMN A DATE ) (ROW 16 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 16 COLUMN C ADDRESS ) (ROW 16 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 16 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 17 COLUMN A DATE ) (ROW 17 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 17 COLUMN C ADDRESS ) (ROW 17 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 17 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 18 COLUMN A DATE ) (ROW 18 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 18 COLUMN C ADDRESS ) (ROW 18 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 18 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 19 COLUMN A DATE ) (ROW 19 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 19 COLUMN C ADDRESS ) (ROW 19 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 19 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 2 COLUMN A DATE ) (ROW 2 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 2 COLUMN C ADDRESS ) (ROW 2 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 2 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 20 COLUMN A DATE ) (ROW 20 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 20 COLUMN C ADDRESS ) (ROW 20 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 20 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 3 COLUMN A DATE ) (ROW 3 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 3 COLUMN C ADDRESS ) (ROW 3 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 3 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 4 COLUMN A DATE ) (ROW 4 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 4 COLUMN C ADDRESS ) (ROW 4 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 4 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 5 COLUMN A DATE ) (ROW 5 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 5 COLUMN C ADDRESS ) (ROW 5 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 5 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 6 COLUMN A DATE ) (ROW 6 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 6 COLUMN C ADDRESS ) (ROW 6 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 6 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 7 COLUMN A DATE ) (ROW 7 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 7 COLUMN C ADDRESS ) (ROW 7 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 7 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 8 COLUMN A DATE ) (ROW 8 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 8 COLUMN C ADDRESS ) (ROW 8 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 8 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (ROW 9 COLUMN A DATE ) (ROW 9 COLUMN B FOR WHOM BOTTLED NAME OF OWNER OF BULK DISTILLED SPIRITS BEFORE BOTTLING IF OTHER THAN LICENSEE SHOW ABOVE ) (ROW 9 COLUMN C ADDRESS ) (ROW 9 COLUMN D BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) 100 PROOF AND UNDER ) (ROW 9 COLUMN E BOTTLED PER FEDERAL REPORTS WINE GALLONS (after bottling) OVER 100 PROOF ) (totals from previous page) 100 ProoF A B C D E ACCoUnt nUMBEr acquired ADDRESS agent AnD UnDEr available blended Board BoE 240 A (BACK) rEV 2 (10 10) BoE 240 A (Front) rEV 2 (10 10) StAtE oF CALIFornIA bottled bottled or packaged whether or not the distilled spirits are owned by the licensee BOTTLED PER FEDERAL REPORTS bottling BOTTLING brandy BUSInESS ADDrESS (street city state and zip code) COLuMN department DEPARTMENT distilled distilled DISTILLED DISTILLED SPIRITS RECEIVED FROM OWN BOTTLING DEPARTMENT BoArD oF EQUALIZAtIon duplicate employees Enter address of person for whom distilled spirits were bottled Enter business address including zip code Enter date distilled spirits were bottled Enter entire account number Enter name of person for whom distilled spirits were bottled Enter owner or company name Enter page number and number of pages in reporting month Enter reporting month and year Enter total gallons of distilled spirits 100 proof or over (bottled per federal reports) Enter total gallons of distilled spirits 100 proof or under (bottled per federal reports) Equalization Every files FILING For Month oF FOR WHOM BOTTLED include INSTRuCTIONS FOR COMPLETING licensee licensee's manufactured manufacturer manufacturer's nAME oF oWnEr oF BULK DIStILLED SPIrItS BEForE BottLInG IF original othEr thAn LICEnSEE ShoWn ABoVE otherwise packaged packaging Page of Pages Please read the instructions on the reverse before preparing this report PREPARATION Prepare preserve produced readily receipts received record recorded rectified rectifier report REPORT REQuIREMENTS retain retained shall shall Special taxes and Fees P o Box 942879 Sacramento CA 94279 0088 spirits spirits SPIRITS state The original of this report must be mailed to the State Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA 94279 0088 total all entries made in Columns D and E and enter the totals in the boxes at the bottom report TOTALS totals from previous page verification WINE GALLONS (after bottling)

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