Free Cigarette Distributor's Report of Returned Stamps - California

BOE-413-ACTS (FRONT) REV. 1 (4-06)

STATE OF CALIFORNIA

CIGARETTE DISTRIBUTOR'S REPORT OF RETURNED STAMPS

BOARD OF EQUALIZATION

DISTRIBUTOR'S NAME

DISTRIBUTOR'S ACCOUNT NUMBER

ADDRESS (street, city, state, zip code)

TELEPHONE NUMBER

(
CONTACT NAME

) )

CONTACT TELEPHONE NUMBER

(

Please provide the roll serial number, the number of stamps remaining, the corresponding order number, and a description of the stamp problem:
ROLL SERIAL NUMBER NUMBER OF STAMPS REMAINING ORDER NUMBER

DESCRIPTION OF THE STAMP PROBLEM

PLEASE INDICATE HOW THE NUMBER OF STAMPS REMAINING WAS DETERMINED

The roll of stamps referenced above may be defective or non-compliant and cannot be used, as verified by:
NAME OF DISTRIBUTOR REPRESENTATIVE SIGNATURE DATE

NAME OF MEYERCORD TECHNICIAN

SIGNATURE

DATE

BOE-413-ACTS (BACK) REV. 1 (4-06)

INSTRUCTIONS
In the event that you find defective or non-compliant stamps, you should promptly notify Meyercord Revenue at 800-639-3799 and make arrangements to have a Meyercord technician validate the problem stamp issue. You should also notify the Board of Equalization's Cigarette Tax Stamp Desk at 916-341-6923. If the Meyercord technician determines that the stamps cannot be used, you should complete a BOE-413-ACTS, Cigarette Distributor's Report of Returned Stamps for each roll of defective or noncompliant stamps and have the Meyercord technician sign and date each form. Please complete the front side of this form as follows: Indicate your (distributor) name, your account number, your full address, your telephone number, and the name and telephone number of a contact person if applicable. Provide the tax stamp roll serial number, the number of stamps remaining on the roll (per your records), the corresponding order number, a description of the stamp problem, and how the number of remaining stamps was determined. Provide the name, signature and date of signature of both the distributor representative and the Meyercord technician. Fax the completed BOE-413-ACTS, Cigarette Distributor's Report of Returned Stamps to the Cigarette Tax Stamp Program Desk at 916-327-6235. Retain a copy of this form for your records. Enclose the original copy with the defective stamps that are being returned to Meyercord.

CLEAR

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