Form Boe-400-Ltr (S1f) - Renewal Application For Manufacturer/importer Tobacco Products License

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BOE-400-LTR (S1F) REV. 1 (7-12)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
RENEWAL APPLICATION FOR MANUFACTURER/IMPORTER
BOE USE ONLY
TOBACCO PRODUCTS LICENSE
RA-B/A
AUD
REG
FILE
RR-QS
REF
EFF
YOUR ACCOUNT NO.
[
]
FOID
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-0088
READ INSTRUCTIONS
BEFORE PREPARING
CALIFORNIA CIGARETTE AND TOBACCO PRODUCTS LICENSING ACT OF 2003
GENERAL INFORMATION
The State Board of Equalization (BOE) 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). Assembly Bill 1749 (Statutes 2006, chapter 501) requires every manufacturer or
importer of tobacco products to be licensed under the Act. Under the Act, every manufacturer or importer of
chewing tobacco, snuff, or other tobacco products must annually obtain and maintain a license to engage in
the sale of tobacco products.
FILING REQUIREMENTS
You must complete and return this annual certification to the BOE in order to maintain your tobacco products
manufacturer/importer license. This certification must be postmarked on or before the due date. The annual
certification consists of page (S1F) Section I: Tobacco Products Manufacturer/Importer License Account
Information; page (S1B) which includes Section II: Cancellation Notice; Section III: Ownership Change; Section
IV: Business Information Changes; and Section V: Signature; page (S2) which consists of Section VI:
Requirement to Update Schedule of Tobacco Products Brand Family Names and Section VII: Certification for
Renewal of Tobacco Products Manufacturer/Importer License; and, BOE-400-LT1, Schedule of Tobacco
Products Brand Family Names. Your annual certification will not be processed if it is incomplete or not signed
under Section I and Section VII.
SECTION I: TOBACCO PRODUCTS MANUFACTURER/IMPORTER LICENSE ACCOUNT INFORMATION
Please check the tobacco product you are currently manufacturing or importing (check only one box):
Chewing tobacco or snuff
Only tobacco products other than chewing tobacco or snuff
Both chewing tobacco or snuff and other tobacco products
Check box only if you have completed Section II, Section III, and/or Section IV 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.
SIGNATURE
EMAIL ADDRESS
TELEPHONE
PRINT NAME AND TITLE
DATE
(
)
Make a copy of this document and any accompanying schedules for your records.
(continued on reverse)

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