Form BOE-400-LDR Fillable Renewal Application for Distributor's Cigarette and Tobacco Products License

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Download Form BOE-400-LDR

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$1 000 00 ([ FOID ]) (1 Enter the total number of business locations for which you are applying for renewal that you operate at which cigarettes or tobacco products are sold (from Schedule A if more than one location) 1 ) (1) NEW BUSINESS OR TRADE NAME/DBA) (2) NEW LOCATION OF BUSINESS (do not use a PO Box or agent's address for location of business)) (3 TOTAL AMOUNT DUE AND PAYABLE (multiply line 1 times line 2)) (3) NEW MAILING ADDRESS (if different from business location; do not enter agent's address here)) (4) NEW AGENT/BOOKKEEPER NAME) (8) NEW AGENT/BOOKKEEPER TELEPHONE NUMBERNEW AGENT/BOOKKEEPER TELEPHONE NUMBER) (9) NEW AGENT/BOOKKEEPER MAILING ADDRESS) (ACCOUNT NUMBER:) (B O E Use Only) (button) CLEAR (button) PRINT (continued on reverse) (Date business discontinued:) (DATE) (DAYTIME TELEPHONE (AREA CODE)) (Daytime telephone number) (DAYTIME TELEPHONE NUMBER) (Daytime telephone number:) (EMAIL ADDRESS) (EMAIL ADDRESS) (FROM:) (I changed the ownership type of my business on:) (If you are storing cigarettes and/or tobacco products at a California location other than your sales location please list all storage locations (attach additional page if necessary) ) (including (Mailing Address:) (must provide if not listed below) (NEW AGENT/BOOKKEEPER MAILING ADDRESS) (NEW AGENT/BOOKKEEPER TELEPHONE (AREA CODE)) (OWNER NAME:) (PERIOD:) (PRINT NAME AND TITLE) (Row 1 B O E Use Only) (Row 1 Column A BUSINESS NAME (must provide if not listed below)) (Row 1 Column B BUSINESS ADDRESS) (Row 1 Column C TELEPHONE NUMBER (including area code)) (Row 1 Column D EMAIL ADDRESS) (Row 1 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION TOTAL NUMBER OF LICENSES REQUIRED:) (Row 1 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 10 B O E Use Only) (Row 10 Column A BUSINESS NAME (must provide if not listed below)) (Row 10 Column B BUSINESS ADDRESS) (Row 10 Column C TELEPHONE NUMBER (including area code)) (Row 10 Column D EMAIL ADDRESS) (Row 10 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 2 B O E Use Only) (Row 2 Column A BUSINESS NAME (must provide if not listed below)) (Row 2 Column B BUSINESS ADDRESS) (Row 2 Column C TELEPHONE NUMBER (including area code)) (Row 2 Column D EMAIL ADDRESS) (Row 2 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 3 B O E Use Only) (Row 3 Column A BUSINESS NAME (must provide if not listed below)) (Row 3 Column B BUSINESS ADDRESS) (Row 3 Column C TELEPHONE NUMBER (including area code)) (Row 3 Column D EMAIL ADDRESS) (Row 3 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 4 B O E Use Only) (Row 4 Column A BUSINESS NAME (must provide if not listed below)) (Row 4 Column B BUSINESS ADDRESS) (Row 4 Column C TELEPHONE NUMBER (including area code)) (Row 4 Column D EMAIL ADDRESS) (Row 4 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 5 B O E Use Only) (Row 5 Column A BUSINESS NAME (must provide if not listed below)) (Row 5 Column B BUSINESS ADDRESS) (Row 5 Column C TELEPHONE NUMBER (including area code)) (Row 5 Column D EMAIL ADDRESS) (Row 5 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 6 B O E Use Only) (Row 6 Column A BUSINESS NAME (must provide if not listed below)) (Row 6 Column B BUSINESS ADDRESS) (Row 6 Column C TELEPHONE NUMBER (including area code)) (Row 6 Column D EMAIL ADDRESS) (Row 6 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 7 B O E Use Only) (Row 7 Column A BUSINESS NAME (must provide if not listed below)) (Row 7 Column B BUSINESS ADDRESS) (Row 7 Column C TELEPHONE NUMBER (including area code)) (Row 7 Column D EMAIL ADDRESS) (Row 7 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 8 B O E Use Only) (Row 8 Column A BUSINESS NAME (must provide if not listed below)) (Row 8 Column B BUSINESS ADDRESS) (Row 8 Column C TELEPHONE NUMBER (including area code)) (Row 8 Column D EMAIL ADDRESS) (Row 8 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (Row 9 B O E Use Only) (Row 9 Column A BUSINESS NAME (must provide if not listed below)) (Row 9 Column B BUSINESS ADDRESS) (Row 9 Column C TELEPHONE NUMBER (including area code)) (Row 9 Column D EMAIL ADDRESS) (Row 9 Column E ENTER 1 IF CIGARETTE OR TOBACCO PRODUCTS WILL BE SOLD AT THIS LOCATION) (TELEPHONE (AREA CODE)) (TELEPHONE NUMBER AREA CODE) (TELEPHONE NUMBER) (text) (text) (text) (the Act) The Act requires every distributor of cigarettes or tobacco products in this state to be licensed by the BOE Under (TO:) (YOUR ACCOUNT NO ) [ FOID 1 Enter the total number of business locations for which you are applying for renewal that 1) NEW BUSINESS OR TRADE NAME/DBA 2 Annual license renewal fee per business location 2 2) NEW LOCATION OF BUSINESS (do not list PO Box or agent's address for location of business) 3 TOTAL AMOUNT DUE AND PAYABLE (multiply line 1 x line 2) 3) NEW MAILING ADDRESS (if different from business location; do not enter agent's address here) 4) NEW AGENT/BOOKKEEPER NAME 5) NEW AGENT/BOOKKEEPER MAILING ADDRESS 800 400 7115 (TTY:711); from the main menu select the option Special Taxes and Fees Customer service representatives are A change in the ownership type of your business requires a new license to be issued You can apply for accounts licenses and ACCOUNT NUMBER: address of all storage locations (attach additional page if necessary) Always write your account number on your check or money order Make a copy of this document for your records AND TOBACCO PRODUCTS LICENSE and Tobacco Products Licensing Act of 2003 or any rule of the State Board of Equalization applicable to the applicant (including area code) asserts the truth of any material matter that he or she knows to be false is guilty of a misdemeanor punishable by imprisonment AT THIS LOCATION available weekdays from 8:00 a m to 5:00 p m (Pacific time) except state holidays BEFORE PREPARING BOARD OF EQUALIZATION BOARD OF EQUALIZATION BOE 400 LDR (S1B) REV 3 (7 12) BOE 400 LDR (S1F) REV 3 (7 12) STATE OF CALIFORNIA BOE 400 LDR (S2) REV 3 (7 12) BOE USE ONLY BUSINESS ADDRESS BUSINESS NAME by an authorized agent a properly completed power of attorney form must be attached to this application by me and to the best of my knowledge and belief is a true correct and complete application CALIFORNIA CIGARETTE AND TOBACCO PRODUCTS LICENSING ACT OF 2003 call our Taxpayer Information Section for assistance at 800 400 7115 (TTY:711) Check box only if you have completed Section II Section III and/or Section IV of this form Cigarette and Tobacco Products License Renewal Fee Computation; page (S1B) which includes Section II: Cancellation DAYTIME TELEPHONE NUMBER Daytime telephone number: each general partner and each person who has control as defined in California Business and Professions Code section 22971(p)) EMAIL ADDRESS ENTER 1 FILING REQUIREMENTS FROM: GENERAL INFORMATION HOW DO I PAY? You can make your payment online by ACH Debit (ePay) credit card Electronic Funds Transfer (EFT) I affirm that the applicant (including each general partner and each person who has control as defined in California Business and I am no longer in business Date business discontinued: I certify that all the information provided in this application is complete true and accurate I understand that any person who I changed the ownership type of my business on: I hereby certify that this application including any accompanying schedules and statements has been examined IF CIGARETTE OR If you are storing cigarettes and/or tobacco products at a California location other than your sales location please list the If you are storing cigarettes and/or tobacco products at a California location other than your sales location please refer to If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 Licensing Act of 2003 under Division 8 6 (commencing with section 22970) of the California Business and Professions Code LLC attach articles of organization which authorize the individual who signs below to certify this application If signed Mailing Address: make a payment or go directly to www boe ca gov/elecrsrv/eServices htm Make check or money order payable to State Board of Equalization nature of any violation or reasons that will prevent you from complying with the requirements with respect to the statement ) NEW AGENT/BOOKKEEPER EMAIL ADDRESS NEW AGENT/BOOKKEEPER TELEPHONE NUMBER Note: This must be signed by an owner partner corporate officer LLC member or manager or by an authorized agent For a Notice; Section III: Ownership Change; Section IV: Business Information Changes; Section V: Additional Information; NUMBER of up to one year in county jail or a fine of not more than one thousand dollars ($1 000) or both the fine and imprisonment or not signed under Section I and Section VI The completed renewal application must be accompanied by a remittance OWNER NAME: P O BOX 942879 paper check or money order Please visit our website at www boe ca gov and click on the eServices tab and log in to partner and each person who has control as defined in California Business and Professions Code section 22971(p)) also agrees partnership attach authorization signed by all general partners; for a corporation attach corporate resolution; and for a payable to the State Board of Equalization for the amount of the license renewal fee due PERIOD: permits using eRegistration (eReg) available on our website at www boe ca gov eReg is also available in our field offices Please pertaining to the manufacture sale or distribution of cigarettes or tobacco products The applicant (including each general PRINT NAME AND TITLE products Products License) You must complete Section VI and return this renewal to the BOE Professions Code (If you are unable to affirm this statement you must provide the BOE with a separate statement containing the Professions Code section 22971(p)) has not been convicted of a felony under sections 30473 or 30480 of the Revenue and RA B/A AUD REG READ INSTRUCTIONS RENEWAL APPLICATION FOR DISTRIBUTOR'S CIGARETTE RR QS FILE REF SACRAMENTO CA 94279 0088 Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at SCHEDULE A DISTRIBUTOR'S BUSINESS LOCATIONS RENEWAL SECTION I: CIGARETTE AND TOBACCO PRODUCTS LICENSE RENEWAL FEE COMPUTATION SECTION II: CANCELLATION NOTICE (complete this section only if you will not be maintaining your Distributor's Cigarette and Tobacco SECTION III: OWNERSHIP CHANGE (you must complete Section VI and return this renewal to the BOE) SECTION IV: BUSINESS INFORMATION CHANGES (complete this section only if you have changes to any of the fields below) Section V on the second page SECTION V: ADDITIONAL INFORMATION SECTION VI: SIGNATURE Section VI: Signature; and Schedule A (if enclosed) Your renewal application will not be processed if it is incomplete SIGNATURE EMAIL ADDRESS SPECIAL TAXES AND FEES STATE OF CALIFORNIA STORAGE LOCATIONS Taxation Code and has not violated and will not violate or cause or permit to be violated any of the provisions of the Cigarette TELEPHONE TELEPHONE than one location) the Act every distributor must annually obtain and maintain a license to engage in the sale of cigarettes or tobacco The State Board of Equalization (BOE) is responsible for administering the California Cigarette and Tobacco Products This application must be postmarked on or before the due date The renewal application consists of page (S1F) Section I: to comply with the reporting payment recordkeeping and license display requirements as specified in the Cigarette and TOBACCO PRODUCTS Tobacco Products Licensing Act of 2003 under Division 8 6 (commencing with section 22970) of the California Business and TOTAL NUMBER OF LICENSES REQUIRED: WILL BE SOLD You must complete and return this application to the BOE in order to maintain your cigarette and tobacco products license you operate at which cigarettes or tobacco products are sold (from Schedule A if more YOUR ACCOUNT NO

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