Free Cigarette and Tobacco Product Retailer License Close-Out Letter and Reinstatement Request - California

STATE OF CALIFORNIA
BOE-400-RLF REV. 1 (1-08)

BOARD OF EQUALIZATION
BOARD USE ONLY
RA-B/A RR-QS YOUR ACCOUNT NO. EFF AUD FILE REG REF

CIGARETTE AND TOBACCO PRODUCTS LICENSE REINSTATEMENT REQUEST FOR THE PERIOD OF

BOARD OF EQUALIZATION EXCISE TAXES DIVISION PO BOX 942879 SACRAMENTO CA 94279-7074

CALIFORNIA CIGARETTE AND TOBACCO PRODUCTS LICENSING ACT OF 2003
GENERAL INFORMATION The State Board of Equalization (BOE) is responsible for administering the California Cigarette and Tobacco Products Licensing Act of 2003 under Division 8.6 (commencing with section 22970) of the California Business and Professions Code (the Act). The Act requires every retailer of cigarettes or tobacco products in this state to be licensed by the BOE. Under the Act, every retailer must obtain and maintain a separate license for each location at which cigarettes or tobacco products are sold. A retailer must conspicuously display the license at each retail location. Effective January 1, 2008, Senate Bill 625 (Statutes of 2007, Chapter 654), requires any retailer who has allowed their Cigarette and Tobacco Products Retailer's License to expire, to pay a reinstatement fee of $100.00 in order to receive a renewal license. If more than one location exists, the reinstatement fee applies to each license which has expired. This fee will not be accepted to reinstate a previously revoked license.

1. Enter the total number of business locations you will be reinstating 2. Reinstatement fee per location 3. TOTAL AMOUNT DUE AND PAYABLE (multiply line 1 by line 2)

1. 2. 3. $100.00

IF PAID BY CREDIT CARD, CHECK HERE. [
SIGNATURE TITLE

]

PRINT NAME

PHONE NUMBER

DATE

Make check or money order payable to State Board of Equalization. Always write your account number on your check or money order. Make a copy of this document for your records.
CLEAR PRINT

RLF

400RLF 001