Form Boe-1056 (Front) - Vendor'S Report Of Beer Shipments Into California

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BOE-1056 (FRONT) REV. 11 (8-12)
STATE OF CALIFORNIA
VENDOR’S REPORT OF BEER SHIPMENTS INTO CALIFORNIA
BOARD OF EQUALIZATION
filed pursuant to Certificate of Compliance
IMPORTANT—Read instructions on reverse side before completing report.
(a)
(b)
(c)
FOR MONTH OF
BOE ACCOUNT NUMBER
Year
Page
of
Pages
(d)
(e)
(street, city, state, and zip code)
NAME
MAILING ADDRESS
1
2
3
4
5
6
7
8
BILL OF LADING
INVOICE
PACKAGES
TOTAL
CALIFORNIA CITY/
CARRIER NAME OR
R.R. CAR NO. OR
GALLONS
NAME OF LICENSED IMPORTER
BOE ACCOUNT NUMBER
DESTINATION
STEAMSHIP LINE
TRUCK TRAILER NO.
BEER
DATE
NUMBER
NUMBER
TYPE
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
071 ­
(f)
(g)
SIGNATURE
PRINT NAME AND TITLE
(h)
(i)
TELEPHONE
EMAIL ADDRESS
CLEAR
PRINT

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