BOE-501-TIM (FRONT) REV. 5 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
TOBACCO PRODUCTS MANUFACTURER/IMPORTER RETURN OF
TAXABLE DISTRIBUTIONS OF SAMPLES IN CALIFORNIA
BOE USE ONLY
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-0056
READ INSTRUCTIONS
BEFORE PREPARING
GENERAL
The California State Board of Equalization (BOE) is responsible for administering the California Cigarette and Tobacco Products
Tax Law. The law imposes a tax upon the distribution of tobacco products based on the wholesale cost of these products. This
includes the distribution of untaxed tobacco products as samples by a manufacturer/importer or its agents or representatives.
The tax rate is determined annually by the BOE and is equivalent to the combined rate of tax imposed on cigarettes.
FILING REQUIREMENTS
Every person that manufactures or imports tobacco products shall file this tax return on or before the 25th day of the month
following the month for which the tax is due. The giving away in this state of untaxed tobacco products as samples is a taxable
distribution and each package of sample tobacco products distributed shall be clearly marked as a sample. With the exception of
line 1A below, the return should only include taxable distributions of sample tobacco products.
Detail of nontaxable transactions shall be furnished to the BOE on BOE-501-MIT.
1A. Total wholesale cost of nontaxable transactions reported on BOE-501-MIT,
1A.
$
column H.
Round cents to the
nearest whole dollar
WHOLESALE
COST
1. Samples of snuff (including moist) and chewing tobacco
1.
$
.00
2. Samples of pipe tobacco
2.
$
.00
3. Samples of cigars
3.
$
.00
4. Samples of roll your own
4.
$
.00
5. Other Samples (Please provide description of other tobacco product samples in the space
5.
$
.00
provided.)
6. Total distributions subject to tax (add wholesale cost, lines 1 through 5)
6.
$
.00
7. Tax Rate
7.
.00
8. Total amount of tax due (multiply line 6 by line 7)
8.
$
.00
9. Penalty [multiply line 8 by 10% (0.10) if payment is made after due date shown above]
9.
$
10.
10.
$
.00
INTEREST: One month's interest is due on tax for each month or fraction of a month that payment is
delayed after the due date. The adjusted monthly interest rate is
11. TOTAL AMOUNT DUE AND PAYABLE (add lines 8, 9, and 10)
11.
$
.00
EMAIL ADDRESS
I hereby certify that this return, 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 return.
SIGNATURE
PRINT NAME AND TITLE
TELEPHONE
DATE
(
)
Make check or money order payable to State Board of Equalization.
Always write your account number on your check or money order. Make a copy of this document for your records.
CLEAR
PRINT