BOE-501-CM (S1F) REV. 9 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
CIGARETTE MANUFACTURER'S TAX RETURN OF
TAXABLE DISTRIBUTIONS IN CALIFORNIA
BOE USE ONLY
RA-B/A
AUD
REG
DUE ON OR BEFORE
FILE
RR-QS
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-6067
READ INSTRUCTIONS
BEFORE PREPARING
As a cigarette manufacturer in California, you are required to report all taxable distributions on lines one through
four of the return. You are also required to report all distributions on the schedules identified in this form where
applicable. Round all quantities and dollars reported to the nearest whole number.
NUMBER OF
CIGARETTES
1. Samples in packages of 5 or less cigarettes
1.
2. Samples in packages of more than 5 cigarettes
2.
3. Taxable sales to the U.S. Government
3.
4. Other distributions subject to tax
4.
5. Total distributions subject to tax (add lines 1 through 4)
5.
6. Rate of tax per cigarette
6.
$
7. Total amount of tax due (multiply line 5 by line 6)
7.
$
8. Penalty [multiply line 7 by 10% (0.10) if payment is made after due date indicated
8.
$
above]
9. INTEREST:
One month's interest is due on tax for each month or fraction of a month that
9.
$
payment is delayed after the due date. The adjusted monthly interest rate is
10. TOTAL AMOUNT DUE AND PAYABLE (add lines 7, 8, and 9)
10.
$
CERTIFICATION
I hereby consent to disclose and authorize the Board of Equalization (BOE) to release, as necessary, certain otherwise confidential
transaction information regarding quantities, invoice numbers, bills of lading, locations, dates, method of delivery, or any other applicable
information to any person identified by me in this tax form as being involved in a reported transaction for the sole purpose of verifying the
accuracy of the reportable product transaction information concerning my transactions with such person as reported in this tax form.
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 the State Board of Equalization.
Always write your account number on your check or money order. This return must be signed.
Make a copy of this document and the accompanying schedules for your records.
CLEAR
PRINT
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2
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