Form Boe-400-Eti - Application For Registration - Excise Taxes - 2010

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  General Partnership
  Limited Liability Partnership
  General Partnership
  Limited Partnership
  Limited Liability Partnership
  Registered Domestic Partnership
BOE-400-ETI (FRONT) REv. 7 (1-10)
STATE OF CALIFORNIA
APPLICATION FOR REGISTRATION — EXCISE TAXES
BOARD OF EQuALIZATION
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 OwNERSHIP
TAX
OFFICE
NUMBER
Sole Owner
Sole Owner
Husband/wife
Photocopies of �
ET
driver license and social
Co-ownership
security card are required �
Enter Federal Employer Identification Number, (FEIN), if any
Each owner, co-owner, or partner must complete lines 2 through 9 and sign line 10. �
If needed, please attach additional sheet(s) to include information for more than two partners. �
OwNER OR PARTNER
CO-OwNER OR PARTNER
2. FuLL NAME
(first, middle, last)
3. RESIDENCE
ADDRESS
(enter full address
including zip code)
4. TELEPHONE NO.
(
)
(
)
(residence)
5. DAYTIME
(
)
(
)
TELEPHONE NO.
6. SOCIAL
SECuRITY NO.
7 . DRIvER LICENSE
NO., STATE OF
ISSuE, AND DATE
OF BIRTH
8. PRESENT/PAST
EMPLOYER
9. NAME, ADDRESS
1.
1.
AND TELEPHONE
NO. OF TwO
PERSONAL
2.
2.
REFERENCES
10. SIGNATuRE
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
4. DATE STARTED IN CALIFORNIA (month, day, year)
5. DAYS AND HOuRS
SuN.
MON.
TuE.
wED.
THuRS.
FRI.
SAT.
OF OPERATION
6. ARE YOu
Starting a new business?
Making Internet sales? website address (http)
Adding/dropping partner?
Buying a business?
Other
7. IF APPLICABLE, PLEASE INDICATE NAME OF FORMER OwNER AND ACCOuNT NuMBER
8. NAME OF BOOkkEEPER/ACCOuNTANT
ADDRESS
TELEPHONE NuMBER
(
)
9. REAL ESTATE OwNED — DESCRIPTION/ADDRESS (business/personal)
vALuE
AMOuNT OwING
(Continued on reverse)

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