Form Boe-240-A - Distilled Spirits Received From Own Bottling Department
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2BoE-240-A (Front) rEV. 2 (10-10)
StAtE oF CALIFornIA
DISTILLED SPIRITS RECEIVED FROM OWN BOTTLING DEPARTMENT
BoArD oF EQUALIZAtIon
Please read the instructions on the reverse before preparing this report.
ACCoUnt nUMBEr
For Month oF
20
Page
of
Pages
(street, city, state and zip code)
nAME
BUSInESS ADDrESS
BOTTLED PER FEDERAL REPORTS
FOR WHOM BOTTLED
WINE GALLONS (after bottling)
ADDRESS
DATE
nAME oF oWnEr oF BULK DIStILLED SPIrItS BEForE BottLInG IF
100 ProoF
oVEr
othEr thAn LICEnSEE ShoWn ABoVE
AnD UnDEr
100 ProoF
A
B
C
D
E
totals from previous page
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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
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