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Form BOE-217 Fillable Common Carrier's Report of Delivery
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)order ((Account No )) (Account No ) (BOE USE ONLY CODE NUMBER Column C Row 10 ) (BOE USE ONLY CODE NUMBER Column C Row 2 ) (BOE USE ONLY CODE NUMBER Column C Row 3 ) (BOE USE ONLY CODE NUMBER Column C Row 4 ) (BOE USE ONLY CODE NUMBER Column C Row 5 ) (BOE USE ONLY CODE NUMBER Column C Row 6 ) (BOE USE ONLY CODE NUMBER Column C Row 7 ) (BOE USE ONLY CODE NUMBER Column C Row 8 ) (BOE USE ONLY CODE NUMBER Column C Row 9 ) (Certified Correct) (CLEAR) CLEAR (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 10 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 2 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 3 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 4 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 5 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 6 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 7 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 8 ) (DELIVERY MADE TO NAME OF LICENSED IMPORTER AND CALIFORNIA CITY Column B Row 9 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 1 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 10 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 2 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 3 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 4 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 5 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 6 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 7 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 8 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES KIND Column I Row 9 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 1 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 10 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 2 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 3 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 4 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 5 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 6 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 7 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 8 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES NUMBER OF PACKAGES Column G Row 9 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 1 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 10 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 2 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 3 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 4 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 5 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 6 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 7 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 8 ) (DESCRIPTION OF ALCOHOLIC BEVERAGES TYPE PACKAGES Column H Row 9 ) (IMPORTANTRead instructions on reverse side before completing report For Month of) (Mailing Address ) (Name of Common Carrier ) (NAME OF SHIPPER CITY AND STATE Column A Row 1 ) (NAME OF SHIPPER CITY AND STATE Column A Row 10 ) (NAME OF SHIPPER CITY AND STATE Column A Row 2 ) (NAME OF SHIPPER CITY AND STATE Column A Row 3 ) (NAME OF SHIPPER CITY AND STATE Column A Row 4 ) (NAME OF SHIPPER CITY AND STATE Column A Row 5 ) (NAME OF SHIPPER CITY AND STATE Column A Row 6 ) (NAME OF SHIPPER CITY AND STATE Column A Row 7 ) (NAME OF SHIPPER CITY AND STATE Column A Row 8 ) (NAME OF SHIPPER CITY AND STATE Column A Row 9 ) (Page ) (Page ; of Pages ) (PRINT) PRINT (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 1 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 10 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 2 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 3 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 4 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 5 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 6 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 7 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 8 ) (R R CAR NO NAME OF VESSEL AND VOYAGE NO OR TRAILER NO Column D Row 9 ) (text) (Title ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 1 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 10 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 2 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 3 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 4 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 5 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 6 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 7 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 8 ) (WAYBILL BILL OF LADING OR FREIGHT BILL DATE Column F Row 9 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 1 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 10 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 2 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 3 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 4 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 5 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 6 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 7 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 8 ) (WAYBILL BILL OF LADING OR FREIGHT BILL NUMBER Column E Row 9 ) (Year) 94279 942879 A B C D E F G H I alcoholic AND CALIFORNIA CITY AND VOYAGE NO BACK) be shown before beverage beverages BILL OF LADING BOARD BOARD OF EQUALIZATION BOE 217 BOE 217 (FRONT) REV 7 (10 10) BOE USE California California California carrier CERTIFICATION Certified Correct CITY AND STATE column column COLUMN COMMON CARRIER S REPORT OF DELIVERY COMPILING complete completing report contained contained must be shown country in which the shipment originated covering deliveries delivery delivery DELIVERY MADE TO DESCRIPTION Do not write in this column duplicate during E & F enter entered entered EQUALIZATION etc ) fifteenth filed filing the report Only page 1 of the report need be certified For Month of freight furnished If the shipment entered California by If the shipment entered California via important importer importer to whom the delivery is made information INSTRUCTIONS interstate lading licensed licensed importer for whom the shipment was delivered made; Mail Address month motor motor carrier must be shown must be shown Name of Common Carrier NAME OF LICENSED IMPORTER NAME OF SHIPPER NAME OF VESSEL notify number number number NUMBER DATE NUMBER OF number) obtained OF ALCOHOLIC BEVERAGES of interstate shipments of alcoholic beverages destined to California points OR FREIGHT BILL OR TRAILER NO original packages PACKAGES KIND pages Prepare public R R CAR NO railroad Read instructions on reverse side before receipt report reported required retain SACRAMENTO shipment shipment shipment shipment shipments shipper showing shown shown on the delivery receipt furnished to the importer SPECIAL state STATE STATE OF CALIFORNIA steamship TAXES The California city in which delivery was made also The correctness of the report must be certified by a representative of the common carrier the preceding calendar month A report must be filed each month whether or not any deliveries are made The report must be completed in each detail as called for under the various headings of the report the truck number the waybill and number This column must show the total number of packages contained in the shipment Title vessel voyage warehouse water WAYBILL which which the shipment was transported into California whiskey gin vodka etc )