Form Boe-400-Lw - Application For Wholesaler'S Cigarette And Tobacco Products License

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BOE-400-LW (S1) REV. 4 (11-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
APPLICATION FOR WHOLESALER'S CIGARETTE AND TOBACCO
BOE USE ONLY
RA-B/A
AUD
REG
PRODUCTS LICENSE
FILE
RR-QS
REF
EFF
YOUR ACCOUNT NO.
[
]
FOID
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 wholesaler of cigarettes or tobacco products in this state to be licensed by the BOE. Under the Act,
every wholesaler must annually obtain and maintain a license to engage in the sale of cigarettes or tobacco products.
FILING REQUIREMENTS
You must complete and return this application to the BOE in order to obtain a cigarette and tobacco products license. The
application consists of page (S1) Section I: Cigarette and Tobacco Products License Fee Computation, page (S2F) which
includes Section II: Ownership Information; Section III: Business Information; and Section IV: Certification, and Schedule A,
(if enclosed). Your application will not be processed if it is incomplete or not signed under Section I and Section IV. The
completed application must be accompanied by a remittance payable to the State Board of Equalization for the amount of
license fee due.
Payments: You can make your payment by paper check, Online ACH Debit (ePay) or by credit card. To use ePay, go to our
website at , click on the eServices tab and log in to make a payment. To pay by credit card, go to our
website or call 800-272-9829 (TTY:711). Be sure to sign and mail your application.
SECTION I: CIGARETTE AND TOBACCO PRODUCTS LICENSE FEE COMPUTATION
1. Enter the total number of business locations that you operate at which cigarettes or
1.
tobacco products are sold (from Schedule A if more than one location)
$1,000.00
2. Annual license fee per business location
2.
3.
TOTAL AMOUNT DUE AND PAYABLE
(multiply line 1 x line 2)
3.
EMAIL ADDRESS
I hereby certify that this application, 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 application.
SIGNATURE
PRINT NAME AND TITLE
DATE
TELEPHONE
(
)
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.

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