Form Boe-400-Lmi2 - Schedule Of Brand Family Names California Cigarette And Tobacco Products Licensing Act Of 2003

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BOE-400-LMI2 REV. 2 (6-07)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
SCHEDULE OF BRAND FAMILY NAMES
CALIFORNIA CIGARETTE AND TOBACCO PRODUCTS LICENSING ACT OF 2003
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 a list of all brand families that it
manufactures or imports.
Complete this schedule and mail it to the State Board of Equalization, Excise Taxes Division, PO Box 942879, Sacramento, CA
94279-0056. If more space is required, you may copy this form.
The reporting company agrees to update the schedule and provide a copy to the State Board of Equalization 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 as required by the California Cigarette and Tobacco Products Licensing Act of 2003 at
section 22979 of the California Business and Professions Code. To obtain additional copies of this form, please call our
Information Center at 800-400-7115.
NAME OF AUTHORIZED AGENT (typed or printed)
TITLE
SIGNATURE OF AUTHORIZED AGENT
DATE
CLEAR
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