Form Boe-400-Lrr - Renewal Applicaiton For Retailer'S Cigarette And Tobacco Products License
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3BOE-400-LRR (S1F) REV. 2 (7-07)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
RENEWAL APPLICATION FOR RETAILER'S CIGARETTE AND TOBACCO PRODUCTS 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 retailer of cigarettes or tobacco products in this state
to be licensed by the Board. Under the Act, every retailer must obtain and maintain a separate license for each
location at which cigarettes or tobacco products are sold. A retailer must conspicuously display the license at
each retail location.
FILING REQUIREMENTS
You must complete and return this renewal application to the Board in order to maintain your cigarette and
tobacco products license. This application must be postmarked on or before the due date. The renewal
application consists of page (S1F) Section I: Cigarette and Tobacco Products License Account Information;
page (S1B) which includes Section II: Cancellation Notice; Section III: Business Change; Section IV: Signature;
and Schedule A, (if enclosed). Your renewal application will not be processed if it is incomplete or not
signed under Section I and Section IV.
SECTION I: CIGARETTE AND TOBACCO PRODUCTS LICENSE ACCOUNT INFORMATION
1. Enter the total number of business locations that you operate at which cigarettes
1.
or tobacco products are sold and for which you are applying for renewal (from
Schedule A if more than one location).
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
E-MAIL ADDRESS
TELEPHONE NUMBER
DATE
Make a copy of this document for your records.
(continued on reverse)
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