(CLEAR) CLEAR
(PRINT) PRINT
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
ADDRESS (street city state zip code)
and the name and telephone number of a contact person if applicable
are being returned to Meyercord
at 916 341 6923
BOE 413 ACTS (BACK) REV 1 (4 06)
BOE 413 ACTS (FRONT) REV 1 (4 06) STATE OF CALIFORNIA
BOE 413 ACTS Cigarette Distributor s Report of Returned Stamps for each roll of defective or noncompliant
CIGARETTE DISTRIBUTOR S BOARD OF EQUALIZATION
Cigarette Tax Stamp Program Desk at 916 327 6235
CONTACT NAME
CONTACT TELEPHONE NUMBER
DESCRIPTION OF THE STAMP PROBLEM
DISTRIBUTOR S ACCOUNT NUMBER
DISTRIBUTOR S NAME
Fax the completed BOE 413 ACTS Cigarette Distributor s Report of Returned Stamps to the
If the Meyercord technician determines that the stamps cannot be used you should complete a
In the event that you find defective or non compliant stamps you should promptly notify Meyercord
Indicate your (distributor) name your account number your full address your telephone number
INSTRUCTIONS
Meyercord technician
NAME OF DISTRIBUTOR REPRESENTATIVE
NAME OF MEYERCORD TECHNICIAN
of remaining stamps was determined
Please complete the front side of this form as follows:
PLEASE INDICATE HOW THE NUMBER OF STAMPS REMAINING WAS DETERMINED
Please provide the roll serial number the number of stamps remaining the corresponding order number and a description of the stamp
problem stamp issue You should also notify the Board of Equalization s Cigarette Tax Stamp Desk
problem:
Provide the name signature and date of signature of both the distributor representative and the
Provide the tax stamp roll serial number the number of stamps remaining on the roll (per your
records) the corresponding order number a description of the stamp problem and how the number
REPORT OF RETURNED STAMPS
Retain a copy of this form for your records Enclose the original copy with the defective stamps that
Revenue at 800 639 3799 and make arrangements to have a Meyercord technician validate the
ROLL SERIAL NUMBER NUMBER OF STAMPS REMAINING ORDER NUMBER
SIGNATURE DATE
stamps and have the Meyercord technician sign and date each form
TELEPHONE NUMBER
The roll of stamps referenced above may be defective or non compliant and cannot be used as verified by:
