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Form BOE-1096 Fillable Customs Broker's Report of Transactions
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(11 87) (CLEAR) CLEAR (PRINT) PRINT (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 2 (11 87) 72 10 72 10 72 10 72 10 72 10 Account Also please enter the customs entry type and number B and California city where located Show entry type If shipment is for transshipment to a point and the name of the vessel in which the shipment was transported into California must be shown If the shipment entered California in a and the zone entered (No 3 San Francisco) BEVERAGES bill date and number must be shown bill of lading number must be shown If the shipment entered California BOARD USE ONLY CODE NUMBER BOE 1096 BACK REV by motor carrier the truck trailer number must be by water the by water the arrival date of the vessel and the steamship California enter name of consignee destination and name of common the alcoholic beverages from California (Copies of shipping be retained for verification by representatives of the Board ) California importer Show entry type and number If the alcoholic beverages are for domestic consumption but without CERTIFICATION: Certified Correct Column Column A completing report Customs Broker CUSTOMS BROKER S BOE 1096 delivery delivery or use in California enter name of licensed DESCRIPTION OF ALCOHOLIC DISPOSITION Do not write in this column it is for Board use only Do not write in this column it is for the Board use only Enter Lot Number Enter name of Carrier transporting to California Enter Release Date and Entry Number Enter the kind of alcoholic beverages contained in the shipment i e beer wine whiskey Enter the kind of alcoholic beverages i e beer champagne whiskey gin rum etc Enter the name of the person or firm in whose the zone and the zone from which released (No B Enter the name of the shipper and the city and Enter the number of wine gallons contained in the release Enter the number of wine gallons contained in the shipment For mixed shipments containing more than one kind of alcoholic beverage enter the number of gallons of each kind Enter the total number and type of packages contained in the release from the foreign trade zone Enter the total number of packages contained in the shipment and the type of packages Enter the type of packages contained in the shipment i e cs ctn bbl drum etc Enter the type of packages i e cs ctn bbl drum etc foreign trade zone enter name of person or firm for whom entered FRONT GALLONSNUMBER gin rum etc i e cs ctn bbl drum etc If a multiple page report is filed only page 1 of the report need be certified If shipment entered a If shipment is for If the alcoholic beverages are for If the shipment entered California IMPORTANT Read instructions on reverse side Mail Address in which the shipment INSTRUCTIONS involving interstate For Month of Leave Blank month regardless of whether there This report must be completed in instructions NAME OF CARRIER NAME OF SHIPPER CITY NUMBER OF PACKAGES OF EQUALIZATION or motor carrier the waybill or freight OR TRAILER originated PACKAGES pages Prepare in Duplicate and mail Original State Board of Equalization P O Box 942879 Sacramento R R CAR NO NAME OF VESSEL AND VOYAGE NO railroad car the car number of the car in which report must be filed each report on this form must be filed during the preceding calendar A SHIPMENT (SEE INSTRUCTION B ON REVERSE) Shipment Entering California by Common Shipments Entering California from Zone shown STATE STATE BOARD state or country the shipment was contained must be shown If the shipment entered California Title use in California enter name of licensed California importer via railroad voyage number WAYBILL BILL OF LADING OR FREIGHT BILL without California enter name of consignee destination and name of common carrier transporting shipment of shipping documents must be retained for verification by representatives If shipment entered a