Form Boe-1071 - Common Carrier'S Report Of Cigarette Deliveries

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BOE-1071 (FRONT) REV. 4 (10-10)
STATE OF CALIFORNIA
COMMON CARRIER’S REPORT OF CIGARETTE DELIVERIES
BOARD OF EQUALIZATION
of Interstate or Foreign Shipments of Cigarettes Destined California Points
(For BOE Use Only)
CODE NUMBER
FOR MONTh OF
IMPORTANT—Read instructions on reverse side before completing report.
Year
Page
of
Pages
NAME OF CARRIER
MAILING ADDRESS
RAILROAD WAYBILL OR
R.R. CAR NUMBER
SHIP BILL OF LADING OR
NAME OF CONSIGNEE AND
OR NAME OF VESSEL
NUMBER OF
NAME OF SHIPPER
BOE USE ONLY
SIZE OF CASE
MOTOR CARRIER
CALIFORNIA CITY WHERE
OR TT IF BY
ORIGIN (CITY AND STATE OR COUNTRY)
CODE NUMBER
CASES OR BALES
OR BALE
PRO NUMBER
DELIVERY MADE
MOTOR CARRIER
DATE
NUMBER
A
D
H
B
C
E
F
G
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
CERTIFIED CORRECT
TITLE
CLEAR
PRINT

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