Form BOE-241-A Fillable Distilled Spirits Purchased or Received From Other Licensees in California

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(ACCOUNT NUMBER) (BOE use only) (BUSINESS ADDRESS street city state and ZIP code ) (CLEAR) CLEAR (COLUMN I WINE GALLONS 100 PROOF AND UNDER Totals from previous page ) (COLUMN J WINE GALLONS OVER 100 PROOF TOTALS ) (COLUMN J WINE GALLONS OVER 100 PROOF Totals from previous page ) (DATE ) (FOR MONTH OF ) (I WINE GALLONS 100 PROOF AND UNDER TOTALS ) (NAME ) (of Pages ; Page) (Page) (PRINT) PRINT (ROW 1 COLUMN A PURCHASED FROM ) (ROW 1 COLUMN B CITY ) (ROW 1 COLUMN D DATE RECEIVED ) (ROW 1 COLUMN E REFERENCE NO ) (ROW 1 COLUMN F INVOICE DATE ) (ROW 1 COLUMN G INVOICE NO ) (ROW 1 COLUMN H INVOICE AMOUNT ) (ROW 1 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 1 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 10 COLUMN A PURCHASED FROM ) (ROW 10 COLUMN B CITY ) (ROW 10 COLUMN D DATE RECEIVED ) (ROW 10 COLUMN E REFERENCE NO ) (ROW 10 COLUMN F INVOICE DATE ) (ROW 10 COLUMN G INVOICE NO ) (ROW 10 COLUMN H INVOICE AMOUNT ) (ROW 10 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 10 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 11 COLUMN A PURCHASED FROM ) (ROW 11 COLUMN B CITY ) (ROW 11 COLUMN D DATE RECEIVED ) (ROW 11 COLUMN E REFERENCE NO ) (ROW 11 COLUMN F INVOICE DATE ) (ROW 11 COLUMN G INVOICE NO ) (ROW 11 COLUMN H INVOICE AMOUNT ) (ROW 11 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 11 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 12 COLUMN A PURCHASED FROM ) (ROW 12 COLUMN B CITY ) (ROW 12 COLUMN D DATE RECEIVED ) (ROW 12 COLUMN E REFERENCE NO ) (ROW 12 COLUMN F INVOICE DATE ) (ROW 12 COLUMN G INVOICE NO ) (ROW 12 COLUMN H INVOICE AMOUNT ) (ROW 12 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 12 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 13 COLUMN A PURCHASED FROM ) (ROW 13 COLUMN B CITY ) (ROW 13 COLUMN D DATE RECEIVED ) (ROW 13 COLUMN E REFERENCE NO ) (ROW 13 COLUMN F INVOICE DATE ) (ROW 13 COLUMN G INVOICE NO ) (ROW 13 COLUMN H INVOICE AMOUNT ) (ROW 13 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 13 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 14 COLUMN A PURCHASED FROM ) (ROW 14 COLUMN B CITY ) (ROW 14 COLUMN D DATE RECEIVED ) (ROW 14 COLUMN E REFERENCE NO ) (ROW 14 COLUMN F INVOICE DATE ) (ROW 14 COLUMN G INVOICE NO ) (ROW 14 COLUMN H INVOICE AMOUNT ) (ROW 14 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 14 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 15 COLUMN A PURCHASED FROM ) (ROW 15 COLUMN B CITY ) (ROW 15 COLUMN D DATE RECEIVED ) (ROW 15 COLUMN E REFERENCE NO ) (ROW 15 COLUMN F INVOICE DATE ) (ROW 15 COLUMN G INVOICE NO ) (ROW 15 COLUMN H INVOICE AMOUNT ) (ROW 15 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 15 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 16 COLUMN A PURCHASED FROM ) (ROW 16 COLUMN B CITY ) (ROW 16 COLUMN D DATE RECEIVED ) (ROW 16 COLUMN E REFERENCE NO ) (ROW 16 COLUMN F INVOICE DATE ) (ROW 16 COLUMN G INVOICE NO ) (ROW 16 COLUMN H INVOICE AMOUNT ) (ROW 16 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 16 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 17 COLUMN A PURCHASED FROM ) (ROW 17 COLUMN B CITY ) (ROW 17 COLUMN D DATE RECEIVED ) (ROW 17 COLUMN E REFERENCE NO ) (ROW 17 COLUMN F INVOICE DATE ) (ROW 17 COLUMN G INVOICE NO ) (ROW 17 COLUMN H INVOICE AMOUNT ) (ROW 17 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 17 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 18 COLUMN A PURCHASED FROM ) (ROW 18 COLUMN B CITY ) (ROW 18 COLUMN D DATE RECEIVED ) (ROW 18 COLUMN E REFERENCE NO ) (ROW 18 COLUMN F INVOICE DATE ) (ROW 18 COLUMN G INVOICE NO ) (ROW 18 COLUMN H INVOICE AMOUNT ) (ROW 18 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 18 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 19 COLUMN A PURCHASED FROM ) (ROW 19 COLUMN B CITY ) (ROW 19 COLUMN D DATE RECEIVED ) (ROW 19 COLUMN E REFERENCE NO ) (ROW 19 COLUMN F INVOICE DATE ) (ROW 19 COLUMN G INVOICE NO ) (ROW 19 COLUMN H INVOICE AMOUNT ) (ROW 19 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 19 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 2 COLUMN A PURCHASED FROM ) (ROW 2 COLUMN B CITY ) (ROW 2 COLUMN D DATE RECEIVED ) (ROW 2 COLUMN E REFERENCE NO ) (ROW 2 COLUMN F INVOICE DATE ) (ROW 2 COLUMN G INVOICE NO ) (ROW 2 COLUMN H INVOICE AMOUNT ) (ROW 2 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 2 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 20 COLUMN A PURCHASED FROM ) (ROW 20 COLUMN B CITY ) (ROW 20 COLUMN D DATE RECEIVED ) (ROW 20 COLUMN E REFERENCE NO ) (ROW 20 COLUMN F INVOICE DATE ) (ROW 20 COLUMN G INVOICE NO ) (ROW 20 COLUMN H INVOICE AMOUNT ) (ROW 20 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 20 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 3 COLUMN A PURCHASED FROM ) (ROW 3 COLUMN B CITY ) (ROW 3 COLUMN D DATE RECEIVED ) (ROW 3 COLUMN E REFERENCE NO ) (ROW 3 COLUMN F INVOICE DATE ) (ROW 3 COLUMN G INVOICE NO ) (ROW 3 COLUMN H INVOICE AMOUNT ) (ROW 3 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 3 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 4 COLUMN A PURCHASED FROM ) (ROW 4 COLUMN B CITY ) (ROW 4 COLUMN D DATE RECEIVED ) (ROW 4 COLUMN E REFERENCE NO ) (ROW 4 COLUMN F INVOICE DATE ) (ROW 4 COLUMN G INVOICE NO ) (ROW 4 COLUMN H INVOICE AMOUNT ) (ROW 4 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 4 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 5 COLUMN A PURCHASED FROM ) (ROW 5 COLUMN B CITY ) (ROW 5 COLUMN D DATE RECEIVED ) (ROW 5 COLUMN E REFERENCE NO ) (ROW 5 COLUMN F INVOICE DATE ) (ROW 5 COLUMN G INVOICE NO ) (ROW 5 COLUMN H INVOICE AMOUNT ) (ROW 5 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 5 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 6 COLUMN A PURCHASED FROM ) (ROW 6 COLUMN B CITY ) (ROW 6 COLUMN D DATE RECEIVED ) (ROW 6 COLUMN E REFERENCE NO ) (ROW 6 COLUMN F INVOICE DATE ) (ROW 6 COLUMN G INVOICE NO ) (ROW 6 COLUMN H INVOICE AMOUNT ) (ROW 6 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 6 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 7 COLUMN A PURCHASED FROM ) (ROW 7 COLUMN B CITY ) (ROW 7 COLUMN D DATE RECEIVED ) (ROW 7 COLUMN E REFERENCE NO ) (ROW 7 COLUMN F INVOICE DATE ) (ROW 7 COLUMN G INVOICE NO ) (ROW 7 COLUMN H INVOICE AMOUNT ) (ROW 7 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 7 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 8 COLUMN B CITY ) (ROW 8 COLUMN D DATE RECEIVED ) (ROW 8 COLUMN E REFERENCE NO ) (ROW 8 COLUMN F INVOICE DATE ) (ROW 8 COLUMN G INVOICE NO ) (ROW 8 COLUMN H INVOICE AMOUNT ) (ROW 8 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 8 COLUMN J WINE GALLONS OVER 100 PROOF ) (ROW 9 COLUMN A PURCHASED FROM ) (ROW 9 COLUMN B CITY ) (ROW 9 COLUMN D DATE RECEIVED ) (ROW 9 COLUMN E REFERENCE NO ) (ROW 9 COLUMN F INVOICE DATE ) (ROW 9 COLUMN G INVOICE NO ) (ROW 9 COLUMN H INVOICE AMOUNT ) (ROW 9 COLUMN I WINE GALLONS 100 PROOF AND UNDER ) (ROW 9 COLUMN J WINE GALLONS OVER 100 PROOF ) 100 ProoF 3 (10 10) A B C D E F G H I J accordance ACCoUnt nUMBEr AnD UnDEr below Board BoArD oF EQUALIZAtIon BoE 241 A (BACK) rEV BoE 241 A (Front) rEV 3 (10 10) Box 942879 Sacramento CA 94279 0088 BUSInESS ADDrESS (street city state and zip code) CALIFORNIA CODE NO COLUMN completed DAtE no AMoUnt DISTILLED DISTILLED SPIRITS PURCHASED OR RECEIVED FROM OTHER LICENSEES IN CALIFORNIA Do not write in this column duplicate Enter business address including zip code Enter date the shipment was received Enter entire account number Enter invoice date covering the shipment Enter invoice number covering the shipment Enter owner or company name Enter page number and number of pages in reporting month Enter purchase order number release number or other reference number Enter reporting month and year Enter the name of the California city where the seller's business is located Enter the name of the California seller from whom the distilled spirits were purchased Enter total dollar amount of invoice Enter total gallons of distilled spirits 100 proof or under per seller's invoice Enter total gallons of distilled spirits over 100 proof per seller's invoice Equalization every files FILING For Month oF instructions INSTRUCTIONS FOR COMPLETING INVOICE WINE GALLONS LICENSEES original OTHER Pages Please read the instructions on the reverse before preparing this report PREPARATION Prepare purchase PURCHASED PURCHASED FROM CITY receipt of distilled spirits from another California taxpayer RECEIVED REFERENCE report REPORT REQUIREMENTS retain showing Special SPIRITS State StAtE oF CALIFornIA taxes and Fees P The original of this report must be mailed to the State Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA 94279 0088 total all entries made in Columns I and J and enter the totals in the boxes at the bottom of the report TOTALS totals from previous page

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