Form Boe-400-Ldr - Renewal Application For Distributor'S Cigarette And Tobacco Products License
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3BOE-400-LDR (S1F) REV. 3 (7-12)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
RENEWAL APPLICATION FOR DISTRIBUTOR'S CIGARETTE
BOE USE ONLY
AND TOBACCO PRODUCTS LICENSE
RA-B/A
AUD
REG
FILE
RR-QS
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
P O 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
(the Act). The Act requires every distributor of cigarettes or tobacco products in this state to be licensed by the BOE. Under
the Act, every distributor must annually obtain and maintain a license to engage in the sale of cigarettes or tobacco
products.
FILING REQUIREMENTS
You must complete and return this application to the BOE 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 Renewal Fee Computation; page (S1B) which includes Section II: Cancellation
Notice; Section III: Ownership Change; Section IV: Business Information Changes; Section V: Additional Information;
Section VI: 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 VI. The completed renewal application must be accompanied by a remittance
payable to the State Board of Equalization for the amount of the license renewal fee due.
STORAGE LOCATIONS
If you are storing cigarettes and/or tobacco products at a California location other than your sales location, please refer to
Section V on the second page.
HOW DO I PAY? You can make your payment online by ACH Debit (ePay), credit card, Electronic Funds Transfer (EFT),
paper check or money order. Please visit our website at and click on the eServices tab and log in to
make a payment or go directly to /elecrsrv/eServices.htm.
SECTION I: CIGARETTE AND TOBACCO PRODUCTS LICENSE RENEWAL FEE COMPUTATION
1. Enter the total number of business locations for which you are applying for renewal that
you operate at which cigarettes or tobacco products are sold (from Schedule A if more
1.
than one location)
2. $1,000.00
2. Annual license renewal fee per business location
3. TOTAL AMOUNT DUE AND PAYABLE (multiply line 1 x line 2)
3.
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
PRINT NAME AND TITLE
TELEPHONE
DATE
(
)
Make check or money order payable to State Board of Equalization.
or your records.
Always write your account number on your check or money order. Make a copy of this document f
(continued on reverse)
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