Annual Certification For Manufacturer/importer License Form - 2007
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3BOE-400-LMR (S1F) REV. 1 (7-07)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
ANNUAL CERTIFICATION FOR MANUFACTURER/IMPORTER LICENSE
BOARD USE ONLY
AUD
RA-B/A
REG
FILE
RR-QS
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
EXCISE TAXES DIVISION
P O BOX 942879
SACRAMENTO CA 94279-0056
READ INSTRUCTIONS
BEFORE PREPARING
CALIFORNIA CIGARETTE AND TOBACCO PRODUCTS LICENSING ACT OF 2003
GENERAL INFORMATION
The State Board of Equalization (Board) 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 manufacturer/importer of cigarettes in this state to be
licensed by the Board. Under the Act, every manufacturer/importer must annually certify that all packages of
cigarettes manufactured or imported by that person and distributed in this State fully comply with Revenue
and Taxation Code section 30163, and that the cigarettes are contained in packages that fully comply with the
federal Cigarette Labeling and Advertising Act (15 U.S.C. Sec. 1331 et seq.).
FILING REQUIREMENTS
You must complete and return this annual certification to the Board in order to maintain your cigarette license.
This certification must be postmarked on or before the due date. The annual certification consists of page
(S1F) Section I: Cigarette License Account Information; page (S1B) which includes Section II: Cancellation
Notice; Section III: Business Change; and Section IV: Signature; and page (S2) which consists of Section V:
Requirement to Update Schedule of Brand Family Names and Section VI: Certification for Renewal of
Manufacturer/Importer License; and Schedule of Brand Family Names (BOE-400-LMI2). Your annual
certification will not be processed if it is incomplete or not signed under Section I and Section VI.
SECTION I: CIGARETTE LICENSE ACCOUNT INFORMATION
Check box only if you have completed Section II and/or Section III of this form.
I hereby certify that this application, including any accompanying schedules and statements, has been examined
by me and to the best of my knowledge and belief is a true, correct and complete application.
YOUR SIGNATURE AND TITLE
TELEPHONE NUMBER
DATE
Make a copy of this document for your records.
(continued on reverse)
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