Free Schedule of Tobacco Products Brand Family Names - California

BOE-400-LT1 REV. 2 (2-08)

STATE OF CALIFORNIA

SCHEDULE OF TOBACCO PRODUCTS BRAND FAMILY NAMES

BOARD OF EQUALIZATION

TOBACCO PRODUCTS MANUFACTURER/IMPORTER NAME

ADDRESS

Pursuant to Chapter 4 of the California Business and Professions Code (commencing with section 22979), in order to be eligible for obtaining and maintaining a license, a manufacturer or importer must submit to the Board of Equalization (BOE) a list of all tobacco products brand families that it manufactures or imports. Complete this schedule and mail it to the State Board of Equalization, Excise Taxes Division, PO Box 942879, Sacramento, CA 94279-0056. If more space is required, you may copy this form. BRAND NAME BRAND NAME

As required by the California Cigarette and Tobacco Products Licensing Act of 2003 (California Business and Professions Code section 22979.21), the reporting company must update the schedule and provide a copy to the BOE whenever a new or additional brand is manufactured or imported by the reporting company, or a listed brand is no longer manufactured or imported by the reporting company. To obtain additional copies of this form, please visit our website at www.boe.ca.gov or call our Taxpayer Information Section at 800-400-7115.
NAME OF AUTHORIZED AGENT (typed or printed) TITLE

SIGNATURE OF AUTHORIZED AGENT

TELEPHONE NUMBER

DATE


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