Form Boe-400-Etc - Application For Registration - Excise Taxes - 2010
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2BOE-400-ETC (FRONT) REv. 7 (1-10)
STATE OF CALIFORNIA
appLication for re GiStration — eXciSe taXeS
BOARD OF EQuALIZATION
(corporation/LimiteD LiaBiLitY companY (LLc)/orGaniZation)
CIGARETTE AND TOBACCO
ALCOHOLIC BEvERAGE
EMERGENCY TELEpHONE
ENERGY RESOuRCES
NATuRAL GAS
pRODuCTS TAX LAW
TAX LAW
uSERS SuRCHARGE LAW
SuRCHARGE LAW
SuRCHARGE LAW
Section i: ownerShip information
for Boe uSe onLY
1. pLEASE CHECK TYpE OF O WNERSHIp
taX
office
numBer
photocopy of
Corporation
Limited Liability Company (LLC)
driver license is required
et
Other
2. ENTER FuLL CORpORA TE, LIMITED LIABILITY COMpANY (LLC), OR ORGANIZATION NAME
3. FEDERAL EMpLOYER IDENTIFICATION NuMBER (FEIN)
4. CALIFORNIA CORpORATE OR LLC NuMBER/STATE OF INCORpORATION OR ORGANIZATION
Each owner, corporate officer, or principal must complete lines 5 through 9.
�
If needed, please attach additional sheet(s) to provide the information requested in this application.
�
president
Manager
vice president
Manager
Secretary
Manager
Treasurer
Manager
(CHECK
Member
Trustee
Member
Trustee
Member
Trustee
Member
Trustee
APPROPRIATE
Beneficiary
Beneficiary
Beneficiary
Beneficiary
TITLE)
5. FuLL NAME
(first, middle, last)
6. RESIDENCE
ADDRESS
(enter full address
including zip code)
7. TELEpHONE NO.
(
)
(
)
(
)
(
)
(residence)
8. DAYTIME
(
)
(
)
(
)
(
)
TELEpHONE NO.
9. DRIvER LICENSE
NO., STATE OF
ISSuE, AND DATE
OF BIRTH
Section ii: BuSineSS information
1. BuSINESS OR TRADE NAME (DBA, if any)
BuSINESS TELEpHONE NuMBER
(
)
2. BuSINESS ADDRESS (do not list P.O. Box or mailing service)
CITY
STATE
ZIp CODE
3. MAILING ADDRESS (if different from No. 2 above)
CITY
STATE
ZIp CODE
SuN.
MON.
TuE.
WED.
THuRS.
FRI.
SAT.
4. DATE STARTED IN CALIFORNIA (month, day, year)
5. DAYS AND HOuRS
OF OpERATION
6. ARE YOu
Starting a new business?
Making Internet Sales?
Website Address
(http)
Incorporating an existing sole proprietorship or partnership?
Other
7.
Buying a business?
(if applicable, please indicate name of former owner and account number)
8. NAME OF BOOKKEEpER/ACCOuNTANT
ADDRESS
TELEpHONE NuMBER
(
)
9. REAL ESTATE OWNED BY CORpORATION — DESCRIpTION/ADDRESS
10. NAMES OF CORpORATE BANKS, SAvINGS AND LOANS, CREDIT uNIONS
ADDRESS
ACCOuNT NuMBER
TYpE OF ACCOuNT
11. pARENT CORpORATION (if any)
ADDRESS
12. OTHER ACCOuNT NuMBERS ISSuED TO YOu BY THE BOE
13. BuSINESS RECORDS WILL BE MAINTAINED AT
(Continued on reverse)
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