Form Boe-501-Mit - Schedule - Manufacturer/importer Report Of Tobacco Products Delivered Or Shipped Into California

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BOE-501-MIT (FRONT) REV. 2 (3-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
-
SCHEDULE
MANUFACTURER/IMPORTER REPORT OF TOBACCO PRODUCTS DELIVERED
OR SHIPPED INTO CALIFORNIA
(If additional space is needed, please photocopy the schedule before making entries
or you may download a blank copy of this form at )
Please read instructions on back before preparing.
ACCOUNT NUMBER
MANUFACTURER'S/IMPORTER'S NAME
PERIOD
DUE
A
B
C
D
E
F
G
H
TYPE OF
DATE OF DELIVERY
NAME OF PURCHASER
DISTRIBUTOR'S
INVOICE OR DOCUMENT
TOBACCO PRODUCT
ROLL-YOUR-OWN
WHOLESALE
TOBACCO
OR SHIPMENT
CA LICENSE NO.
NUMBER FOR DELIVERY
BRAND NAME
TOBACCO
COST OF
PRODUCT
OR EXEMPT CODE
OR SHIPMENT
TOBACCO
(Enter one brand per line)
(Enter ounces per line)
(See instructions)
PRODUCTS
Attach additional pages if necessary. Make a copy for your records.
CLEAR
PRINT

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