Application Form And Certification For Manufacturer/importer Cigarette License Page 5
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8BOE-400-LMI2 REV. 4 (1-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
SCHEDULE OF CIGARETTE BRAND FAMILY NAMES
CIGARETTE MANUFACTURER/IMPORTER NAME
ADDRESS
Pursuant to Chapter 4 of the California Business and Professions Code (commencing with section 22979), in order to be
eligible for obtaining and maintaining a license, a manufacturer or importer must submit to the Board of Equalization (BOE) a list
of all brand families that it manufactures or imports.
Complete this schedule and mail it to the Board of Equalization, Special Taxes and Fees, P.O. Box 942879, Sacramento, CA
94279-0088. If more space is required, you may copy this form.
BRAND NAME
BRAND NAME
As required by the California Cigarette and Tobacco Products Licensing Act of 2003 (California Business and Professions Code
section 22979), the reporting company must update the schedule and provide a copy to the BOE whenever a new or additional
brand is manufactured or imported by the reporting company, or a listed brand is no longer manufactured or imported by the
reporting company. To obtain additional copies of this form, please visit our website at or call our Taxpayer
Information Section at 800-400-7115 (TTY: 711).
TITLE
NAME OF AUTHORIZED AGENT
SIGNATURE OF AUTHORIZED AGENT (typed or printed)
TELEPHONE NUMBER
EMAIL ADDRESS
DATE
CLEAR
PRINT
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