BOE-1071 (FRONT) REV. 3 (2-00)
STATE OF CALIFORNIA
COMMON CARRIER'S REPORT OF CIGARETTE DELIVERIES of Interstate or Foreign Shipments of Cigarettes Destined California Points
CODE NUMBER (For Board Use Only)
BOARD OF EQUALIZATION
IMPORTANT -- Read instructions on reverse side before completing report.
NAME OF CARRIER
FOR MONTH OF
NAME OF SHIPPER ORIGIN (CITY AND STATE OR COUNTRY)
NAME OF CONSIGNEE AND CALIFORNIA CITY WHERE DELIVERY MADE
BOARD USE ONLY CODE NUMBER
R.R. CAR NUMBER OR NAME OF VESSEL OR TT IF BY MOTOR CARRIER
RAILROAD WAYBILL OR SHIP BILL OF LADING OR MOTOR CARRIER PRO NUMBER DATE NUMBER
NUMBER OF CASES OR BALES
SIZE OF CASE OR BALE
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
CERTIFIED CORRECT TITLE
BOE-1071 (BACK) REV. 3 (2-00)
INSTRUCTIONS FOR COMPILING STATE BOARD OF EQUALIZATION FORM BOE-1071
Prepare report in duplicate, retain copy and mail original to:
State Board of Equalization Excise Taxes Division P.O. Box 942879 Sacramento, California 94279-0056 A report on this form must be filed on or before the 25th day of each month covering cigarette deliveries made during the preceding calendar month. A report must be filed each month whether or not any deliveries are made.
COLUMN A Enter the complete name of shipper and the city and state or country in which the shipment originated. Enter the name of the consignee to whom delivery was made and the California city in which delivery was made. Do not write in this column -- it is for Board use only. If the shipment entered California by railroad, the car initials and number in which shipment was contained must be shown. If the shipment entered California by water, the voyage number and the name of the vessel in which the shipment was transported into California must be shown. If the shipment entered California by motor carrier, the letters TT must be shown. E &F If the shipment entered California by railroad, the waybill date and number must be shown. If the shipment entered California by water, the steamship bill of lading date and number must be shown. If the shipment entered California by motor carrier, the pro number (or freight bill number) and date must be shown. G H Show the total number of cases or bales of cigarettes contained in the shipment. List (in thousands, i.e., 3M, 5M, 6M, 10M, 12M) the number of cigarettes per case or bale.
Certification: The correctness of the report must be certified to by a representative of the carrier filing the report. Only 1 page of the report need be certified.