Form Boe-400-Lmr - Annual Certification For Manufacturer/importer License
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3BOE-400-LMR (S1F) REV. 2 (7-12)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
ANNUAL CERTIFICATION FOR MANUFACTURER/IMPORTER LICENSE
BOE USE ONLY
AUD
RA-B/A
REG
FILE
RR-QS
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
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 (the Act). The Act requires every manufacturer/importer of cigarettes in this state to be
licensed by the BOE. Under the Act, every manufacturer/importer must annually certify that all packages of
cigarettes manufactured or imported by that person and distributed in this state fully comply with Revenue
and Taxation Code section 30163, and that the cigarettes are contained in packages that fully comply with the
federal Cigarette Labeling and Advertising Act (15 U.S.C. Sec. 1331 et seq.).
FILING REQUIREMENTS
You must complete and return this annual certification to the BOE in order to maintain your cigarette license.
This certification must be postmarked on or before the due date. The annual certification consists of page
(S1F) Section I: Cigarette License Account Information; page (S1B) which includes Section II: Cancellation
Notice; Section III: Ownership Change; Section IV: Business Information Changes; Section V: Signature; page
(S2) which consists of Section VI: Requirement to Update Schedule of Cigarette Brand Family Names; Section
VII: Certification for Renewal of Manufacturer/Importer License; and BOE-400-LMI2, Schedule of Cigarette
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: CIGARETTE LICENSE ACCOUNT INFORMATION
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 a copy of this document including any accompanying schedules for your records.
(continued on reverse)
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