Form Boe-1096 - Customs Broker'S Report Of Transactions

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CUSTOMS BROKER’S REPORT OF TRANSACTIONS
STATE BOARD OF EQUALIZATION
BOE-1096 FRONT REV. 2 (11-87)
involving interstate shipments of alcoholic beverages in Internal Revenue or Customs Bond.
For Month of
19
Page
of
pages
Customs Broker
(Account No.
)
IMPORTANT
Read instructions on reverse side before
completing report
Mail Address
BOARD USE
R.R. CAR NO.
WAYBILL,
DESCRIPTION
OF ALCOHOLIC BEVERAGES
NAME OF SHIPPER
DISPOSITION OF SHIPMENT
BILL OF LADING
ONLY
NAME OF
NAME OF VESSEL
OR FREIGHT BILL
CITY AND STATE
(SEE INSTRUCTION “B” ON REVERSE)
CODE
CARRIER
AND VOYAGE NO.
NUMBER OF
TYPE
NUMBER
OR TRAILER NO.
NUMBER
DATE
PACKAGES
PACKAGES
KIND
GALLONS
A
B
C
D
E
F
G
H
I
J
K
72-10
1
72-10
2
72-10
3
72-10
4
72-10
5
72-10
6
72-10
7
72-10
8
72-10
9
72-10
10
CERTIFICATION: If a multiple page report is filed, only
Certified Correct
page 1 of the report need be certified.
Title

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