Form Boe-400-Lt1 - Schedule Of Tobacco Products Brand Family Names
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1BOE-400-LT1 REV. 4 (5-12)
STATE OF CALIFORNIA
SCHEDULE OF TOBACCO PRODUCTS BRAND FAMILY NAMES
BOARD OF EQUALIZATION
TOBACCO PRODUCTS 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 tobacco products 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 22979.21), 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).
NAME OF AUTHORIZED AGENT (typed or printed)
TITLE
SIGNATURE OF AUTHORIZED AGENT
TELEPHONE NUMBER
EMAIL ADDRESS
DATE
CLEAR
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