Form Boe-241-A - Distilled Spirits Purchased Or Received From Other Licensees In California

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BoE-241-A (Front) rEV. 3 (10-10)
StAtE oF CALIFornIA
DISTILLED SPIRITS PURCHASED OR RECEIVED FROM OTHER LICENSEES IN CALIFORNIA
BoArD oF EQUALIZAtIon
Please read the instructions on the reverse before preparing this report.
ACCoUnt nUMBEr
For Month oF
Year
Page
of
Pages
(street, city, state and zip code)
nAME
BUSInESS ADDrESS
INVOICE
WINE GALLONS
CODE NO.
DATE
REFERENCE
PURCHASED FROM
CITY
100 ProoF
oVEr
(BOE use only)
RECEIVED
NO.
DAtE
no.
AMoUnt
AnD UnDEr
100 ProoF
A
B
C
D
E
F
G
H
I
J
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
PRINT

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