Form BOE-269-A Fillable Beer and Wine Imported into California

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BOE 269 A (BACK) 9 (8 12) ((a) ACCOUNT NUMBER) ((b) FOR MONTH OF ) ((c) Page of) ((d) TAXPAYER (name of Importer)) ((e) ADDRESS (street city state and zip code)) (a) ACCOUNT NUMBER (b) FOR MONTH OF (clear) CLEAR (Column 1 Row 1 Name of Shipper City and State or Country) (Column 1 row 10 Name of Shipper City and State or Country) (Column 1 row 2 Name of Shipper City and State or Country) (Column 1 row 3 Name of Shipper City and State or Country) (Column 1 row 4 Name of Shipper City and State or Country) (Column 1 row 5 Name of Shipper City and State or Country) (Column 1 row 6 Name of Shipper City and State or Country) (Column 1 row 7 Name of Shipper City and State or Country) (Column 1 row 8 Name of Shipper City and State or Country) (Column 1 row 9 Name of Shipper City and State or Country) (Column 10 Row 1 Beer Case Gallons) (Column 10 Row 10 Beer Case Gallons) (Column 10 Row 2 Beer Case Gallons) (Column 10 Row 3 Beer Case Gallons) (Column 10 Row 4 Beer Case Gallons) (Column 10 Row 5 Beer Case Gallons) (Column 10 Row 6 Beer Case Gallons) (Column 10 Row 7 Beer Case Gallons) (Column 10 Row 8 Beer Case Gallons) (Column 10 Row 9 Beer Case Gallons) (Column 10 Totals Beer Case Gallons) (Column 11 Row 1 Beer Keg Gallons) (Column 11 Row 10 Beer Keg Gallons) (Column 11 Row 2 Beer Keg Gallons) (Column 11 Row 3 Beer Keg Gallons) (Column 11 Row 4 Beer Keg Gallons) (Column 11 Row 5 Beer Keg Gallons) (Column 11 Row 6 Beer Keg Gallons) (Column 11 Row 7 Beer Keg Gallons) (Column 11 Row 8 Beer Keg Gallons) (Column 11 Row 9 Beer Keg Gallons) (Column 11 Totals Beer Keg Gallons) (Column 11 Totals for Current Month to Date Brought Forward Beer Keg Gallons) (Column 12 Row 1 Still Wine Not Over 14 Percent Gallons) (Column 12 Row 10 still wine not over 14 percent gallons) (Column 12 Row 2 still wine not over 14 percent gallons) (Column 12 Row 3 still wine not over 14 percent gallons) (Column 12 Row 4 still wine not over 14 percent gallons) (Column 12 Row 5 still wine not over 14 percent gallons) (Column 12 Row 6 still wine not over 14 percent gallons) (Column 12 Row 7 still wine not over 14 percent gallons) (Column 12 Row 8 still wine not over 14 percent gallons) (Column 12 Row 9 still wine not over 14 percent gallons) (Column 12 Totals for Current Month to Date Brought Forward Column 12 Still Wine Not Over 14 Percent Gallons) (Column 12 Totals Still Wine Not Over 14 Percent Gallons) (Column 13 Row 1 Still Wine Over 14 Percent Gallons) (Column 13 Row 10 Still Wine Over 14 Percent Gallons) (Column 13 Row 2 Still Wine Over 14 Percent Gallons) (Column 13 Row 3 Still Wine Over 14 Percent Gallons) (Column 13 Row 4 Still Wine Over 14 Percent Gallons) (Column 13 Row 5 Still Wine Over 14 Percent Gallons) (Column 13 Row 7 Still Wine Over 14 Percent Gallons) (Column 13 Row 8 Still Wine Over 14 Percent Gallons) (Column 13 Row 9 Still Wine Over 14 Percent Gallons) (Column 13 Totals for Current Month to Date Brought Forward Still Wine Over 14 Percent Gallons) (Column 13 Totals Still Wine Over 14 Percent Gallons) (Column 14 Row 1 Sparkling Wine Gallons) (Column 14 Row 10 Sparkling Wine Gallons) (Column 14 Row 2 Sparkling Wine Gallons) (Column 14 Row 3 Sparkling Wine Gallons) (Column 14 Row 4 Sparkling Wine Gallons) (Column 14 Row 5 Sparkling Wine Gallons) (Column 14 Row 6 Sparkling Wine Gallons) (Column 14 Row 7 Sparkling Wine Gallons) (Column 14 Row 8 Sparkling Wine Gallons) (Column 14 Row 9 Sparkling Wine Gallons) (Column 14 Totals for Current Month to Date Brought Forward Sparkling Wine Gallons) (Column 14 Totals Sparkling Wine Gallons) (Column 2 Row 1 Name of Common Carrier) (Column 2 Row 10 name of common carrier) (Column 2 Row 2 name of common carrier) (Column 2 Row 3 name of common carrier) (Column 2 Row 4 name of common carrier) (Column 2 Row 5 name of common carrier) (Column 2 Row 6 name of common carrier) (Column 2 Row 7 name of common carrier) (Column 2 Row 8 name of common carrier) (Column 2 Row 9 name of common carrier) (Column 4 Row 1 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 10 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 2 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 3 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 4 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 5 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 6 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 7 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 8 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 4 Row 9 R R Car No Name of Vessel and Voyage No or Truck Trailer No ) (Column 5 Row 1 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 10 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 2 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 3 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 4 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 5 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 6 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 7 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 8 Waybill Bill of Lading or Freight Bill Number) (Column 5 Row 9 Waybill Bill of Lading or Freight Bill Number) (Column 6 Row 1 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 10 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 2 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 3 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 4 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 5 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 6 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 7 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 8 Waybill Bill of Lading or Freight Bill Date) (Column 6 Row 9 Waybill Bill of Lading or Freight Bill Date) (Column 7 Row 1 Purchased From) (Column 7 Row 10 Purchased From) (Column 7 Row 2 Purchased From) (Column 7 Row 3 Purchased From) (Column 7 Row 4 Purchased From) (Column 7 Row 5 Purchased From) (Column 7 Row 6 Purchased From) (Column 7 Row 7 Purchased From) (Column 7 Row 8 Purchased From) (Column 7 Row 9 Purchased From) (Column 8 Invoice No ) (Column 8 Row 1 Invoice No ) (Column 8 Row 2 Invoice No ) (Column 8 Row 3 Invoice No ) (Column 8 Row 4 Invoice No ) (Column 8 Row 5 Invoice No ) (Column 8 Row 6 Invoice No ) (Column 8 Row 7 Invoice No ) (Column 8 Row 8 Invoice No ) (Column 8 Row 9 Invoice No ) (Column 9 Row 1 Date Received) (Column 9 Row 10 Date Received) (Column 9 Row 2 Date Received) (Column 9 Row 3 Date Received) (Column 9 Row 4 Date Received) (Column 9 Row 5 Date Received) (Column 9 Row 6 Date Received) (Column 9 Row 7 Date Received) (Column 9 Row 8 Date Received) (Column 9 Row 9 Date Received) (Column L Still Wine Over 14 Percent Gallons) (e) ADDRESS (street city state and zip code) (Pages ) (print) PRINT (TTY:711); (Year) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 I Totals for Current Month to Date Brought Forward 800 400 7115 Alcoholic and a beer and wine importer s license shall also include the total imports period on are available weekdays from 8:00 a m to 5:00 p m (Pacific time) except state holidays BEER AND WINE IMPORTED INTO CALIFORNIA before Beverage Beverages BILL OF LADING BOE 269 A (FRONT) REV 9 (8 12) BOE USE ONLYCODE NUMBER 3 74 00 BOE USE ONLYCODE NUMBER 3 74 00 BOE USE ONLYCODE NUMBER 3 74 00 BOE USE ONLYCODE NUMBER 3 74 00 BOE USE ONLYCODE NUMBER 3 74 00 California carrier Column 1 Column 10 Column 11 Column 12 Column 13 Column 14 Column 2 Column 3 Column 4 Column 5 Column 6 Column 7 Column 8 Column 9 Customer day of the month following the close period file form BOE 269 beer and wine received from a point outside of California A wine grower holding both a winegrower s license Do not write in this column enter Enter the date the beer or wine was received Enter the invoice number of the shipment Enter the name of the carrier transporting the shipment into California Enter the name of the person or firm from whom the beer or wine was purchased Enter the name of the shipper and the city and state or country in which the shipment Enter the total gallons of case beer contained in this shipment by dividing total ounces contained in the shipment by 128 Round the result to the nearest gallon Enter the total gallons of keg beer contained in this shipment by multiplying barrels by 31 Enter the total gallons of sparkling wine contained in the shipment Enter the total gallons of wine not over 14 percent alcohol contained in the shipment Enter the total gallons of wine over 14 percent alcohol contained in the shipment Enter the waybill bill of lading or freight bill date Enter the waybill bill of lading or freight bill number entered every Fees P O Box 942879 Sacramento California 94279 0088 For each page complete the information in boxes (a) through (e) at the top of the report Enter (a) your beer and gallons holding If the shipment entered California by water enter the voyage number and the name of the If the shipment entered California in a railroad car enter the car number in which the shipment If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 importer importer s imports in row II Bring these totals forward to the next page of the report by entering them in row I include INSTRUCTIONSBEER AND WINE IMPORTED INTO CALIFORNIA license manufacturer manufacturer s Manufacturer Tax Return motor multiplying liters by 0 264172 Round the result to the nearest gallon NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 1 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 10 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 2 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 3 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 4 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 5 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 6 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 7 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 8 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 9 NAME OF SHIPPERCITY AND STATEOR COUNTRY 1 II TOTALS NAME OF SHIPPERCITY AND STATEOR COUNTRYNAME OFCOMMON CARRIERBOE USE ONLYCODE NUMBERR R CAR NO NAME OF VESSELAND VOYAGE NO number of columns 10 through 14 The final page of the report should contain the grand totals for columns 10 through 14 for all pages option or call the Taxpayer Information Section OR FREIGHT BILLFROMPURCHASEDINVOICE NO OR TRUCK originated page total for columns 10 through 14 Pages(d) TAXPAYER (name of importer) Please read the instructions on the reverse before preparing this report PREPARATION OF REPORT Prepare report in duplicate; retain a copy and mail original to the State Board of Equalization Special Taxes and pursuant RECEIVEDBEERSTILL WINESPARKLINGNUMBERDATECASEGALLONSKEGGALLONSNOT OVER 14PERCENTGALLONSOVER 14PERCENTGALLONSWINE Regulation Report representatives Return Round the result to the nearest gallon Row II Sacramento CA 94279 0088 You may also visit the BOE website at select service shall shipment Special STATE OF CALIFORNIABOARD OF EQUALIZATION Sum the total gallons in each of columns 10 through 14 and enter the result for each column Taxes 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 the report; (d) your business name and (e) your address For page 2 and thereafter in row I enter the previous total trailer TRAILER NO truck vessel in which the shipment was transported into California was contained WAYBILL wine importer account number; (b) the month and year of the report; (c) the page number and the total pages of Winegrower www boe ca gov

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