Form Boe-269-A - Beer And Wine Imported Into California

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BOE-269-A (FRONT) REV. 9 (8-12)
STATE OF CALIFORNIA
BEER AND WINE IMPORTED INTO CALIFORNIA
BOARD OF EQUALIZATION
Please read the instructions on the reverse before preparing this report.
(a)
(b)
(c)
ACCOUNT NUMBER
FOR MONTH OF
Year
Page
of
Pages
(d)
(e)
(street, city, state, and zip code)
TAXPAYER (name of importer)
ADDRESS
BEER
STILL WINE
SPARKLING
R.R. CAR NO.
NAME OF SHIPPER
WAYBILL,
NAME OF VESSEL
CITY AND STATE
NAME OF
BOE USE ONLY
BILL OF LADING,
PURCHASED
DATE
CASE
KEG
NOT OVER 14
OVER 14
WINE
AND VOYAGE NO.
INVOICE NO.
OR COUNTRY
COMMON CARRIER
CODE NUMBER
OR FREIGHT BILL
FROM
RECEIVED
GALLONS
GALLONS
PERCENT
PERCENT
GALLONS
OR TRUCK
GALLONS
GALLONS
TRAILER NO.
NUMBER
DATE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
I. Totals for Current Month to Date Brought Forward
74-00
1.
74-00
2.
74-00
3.
74-00
4.
74-00
5.
74-00
6.
74-00
7.
74-00
8.
74-00
9.
74-00
10.
II. TOTALS
The original of this report must be mailed to the State Board of Equalization, Special Taxes and Fees, P.O. Box 942879, Sacramento, CA 94279-0088.
CLEAR
PRINT

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