Form Boe-356 - Cigarette Distributor'S Application For Deferred Payment Option
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1BOE-356 REV. 3 (6-13)
STATE OF CALIFORNIA
CIGARETTE DISTRIBUTOR’S
BOARD OF EQUALIZATION
APPLICATION FOR DEFERRED PAYMENT OPTION
BUSINESS NAME
DISTRIBUTOR PERMIT NUMBER
CR STF 02
AMOUNT OF DEFERRED CREDIT REQUESTED
$
PAYMENT OPTION (please check only one)
Weekly payment without a security deposit
Weekly payment with a security deposit
Monthly payment
Twice-Monthly payment
CIGARETTE DISTRIBUTOR EMAIL ADDRESS (email address of designated person responsible for payment processing)
CONTACT TELEPHONE NUMBER
(
)
On behalf of the above distributor, the undersigned certifies the following:
Cigarette distributor voluntarily and freely elects to make deferred payments for purchases of cigarette tax stamps
based on the designated option chosen above for a period of at least one year from the date the election is made in
accordance with section 30168 of the Cigarette and Tobacco Products Tax Law.
NAME AND TITLE OF DISTRIBUTOR’S PRINCIPAL OWNER OR AUTHORIZED REPRESENTATIVE
SIGNATURE OF DISTRIBUTOR’S PRINCIPAL OWNER OR AUTHORIZED REPRESENTATIVE
DATE
Depending on the payment option selected, a security deposit may be required. Acceptable types of security deposits
include:
CASH
Funds held by the Board of Equalization (BOE).
DEPOSIT ACCOUNTS
Automatically renewable accounts held in federally insured savings institutions located in California. The account
is held in the name of the BOE unless an assignment form accompanies the evidence of deposit. Original evidence
of deposit, such as certificate, passbook, or deposit receipt (when a certificate or passbook is not issued) must be
submitted to the BOE as support of the deposit.
STATE AND FEDERAL CREDIT UNION SHARES
The California Credit Union League will print and provide the necessary assignment forms.
SURETY BONDS
Insurers issue bonds as evidence of a surety policy. Approved bond forms with an original signature of the Attorney
in-Fact for the Surety must be submitted.
LETTER OF CREDIT
A binding irrevocable letter of credit obtained through your bank or financial institution to guarantee payment. Form
BOE-487-DCB, Irrevocable Letter of Credit, must be submitted to the BOE.
Upon approval of this application, you will be notified in writing of the credit limit and effective start date for your deferred
payments. If your selection is not approved, you will be notified in writing. For more information, visit the BOE website at
You may also call the Taxpayer Information Section at 1-800-400-7115 (TTY:711).
Note to signatory: If you are not a corporate officer, partner, or owner, this signature certifies under penalty of perjury
that you hold power of attorney to authorize permission to elect a deferred payment option for purchasing cigarette tax
stamps.
Mail to:
STATE BOARD OF EQUALIZATION
Special Taxes Policy and Compliance Division
Attn: Stamp Desk, MIC:41
PO Box 942879
Sacramento, CA 94279-0041
CLEAR
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