Form Boe-400-Lmi - Application And Certification For Manufacturer/importer Cigarette License

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BOE-400-LMI (S1) REV. 2 (1-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
APPLICATION AND CERTIFICATION FOR MANUFACTURER/IMPORTER
CIGARETTE LICENSE
BOE USE ONLY
RA-B/A
AUD
REG
FILE
RR-QS
REF
[
]
YOUR ACCOUNT NO.
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-0088
READ INSTRUCTIONS
BEFORE PREPARING
CALIFORNIA CIGARETTE AND TOBACCO PRODUCTS LICENSING ACT OF 2003
GENERAL INFORMATION
The Board of Equalization (BOE) is responsible for administering the California Cigarette and Tobacco
Products Licensing Act of 2003 under Division 8.6 (commencing with section 22970) of the California Business
and Professions Code (the Act). The Act requires every manufacturer or importer of cigarettes in this state to
be licensed by the BOE. Under the Act, every manufacturer or importer of cigarettes must annually certify that
all packages of cigarettes manufactured or imported by that person and distributed in this State fully comply
with Revenue and Taxation Code section 30163, subdivision (b), and that the cigarettes contained in those
packages are the subject of field reports that fully comply with the federal Cigarette Labeling and Advertising
Act (15 U.S.C. Sec. 1331 et seq.) for the reporting of ingredients added to cigarettes.
FILING REQUIREMENTS
You must complete and return this application and certification to the BOE in order to obtain a cigarette
manufacturer/importer license. The application consists of Section I: Ownership Information; Section II:
Business Information; Section III: Requirement To Submit and Update Schedule of Cigarettes and Brand
Family Names; Section IV: Certification of Manufacturer/Importer License; and BOE-400-LMI2, Schedule of
Cigarette Brand Family Names.Your application and certification will not be processed if it is not signed under
Section IV.
I hereby certify that this application and certification, 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 document.
YOUR SIGNATURE AND TITLE
EMAIL ADDRESS
TELEPHONE NUMBER
DATE
LMI
Make a copy of this document for your records.

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