Form BOE-501-CTT Fillable Tobacco Schedule T
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(ACCOUNT NUMBER) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (B OUNCES OF ROLL YOUR OWN TOBACCO SOLD IN CALIFORNIA) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (C NONPARTICIPATING MANUFACTURER NAME AND ADDRESS) (CLEAR) CLEAR (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (D NAME AND ADDRESS OF PERSON FROM WHOM EACH BRAND WAS PURCHASED) (DISTRIBUTOR'S NAME) (DUE) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (E NAME AND ADDRESS OF FIRST IMPORTER OF FOREIGN MANUFACTURED BRANDS) (If additional space is needed please photocopy the schedule before making entries ) (Participating Manufacturers) and the State of California the Board of Equalization must compile information (PERIOD) (PRINT) CLEAR (Row 1 A BRAND NAME ) (Row 10 A BRAND NAME ) (Row 11 A BRAND NAME ) (Row 12 A BRAND NAME ) (Row 13 A BRAND NAME ) (Row 2 A BRAND NAME ) (Row 3 A BRAND NAME ) (Row 4 A BRAND NAME ) (Row 5 A BRAND NAME ) (Row 6 A BRAND NAME ) (Row 7 A BRAND NAME ) (Row 8 A BRAND NAME ) (Row 9 A BRAND NAME ) (www oag ca gov) 800 400 7115 (TTY: 711); from the main menu select the option Special Taxes and Fees about cigarettes and loose leaf tobacco suitable for making cigarettes (roll your own) sold in California and ABRAND NAMEBOUNCES OFROLL YOUR OWN TOBACCO ACCOUNT NUMBER any roll your own tobacco from a Nonparticipating Manufacturer either directly or through a As part of the Master Settlement Agreement between certain cigarette and tobacco manufacturers Attach the schedule to your monthly tax return BOE 501 CT Tobacco Products Distributor Tax Return and BOE 501 CTT (BACK) REV 6 (6 11) BOE 501 CTT (FRONT) REV 6 (6 11) brands can be found on the California Office of the Attorney General's California Tobacco Directory Cigarette Distributor's Tax Return Cigarettes should be listed on the Schedule F that is attached to your BOE 501 CD Column A Enter the brand name of the roll your own tobacco product sold only if the product is not listed Column B Enter the ounces of roll your own tobacco sold Column C Enter the name and address of the Nonparticipating Manufacturer of the brand name sold: Column D Enter the name and address of the person from whom each brand was purchased Column E Enter the name and address of the first importer of the foreign manufactured brand Complete this schedule in full If no activity please check box on line 1A of the BOE 501 CT (S1F) Tobacco distributor An updated list of Participating Manufacturers and Nonparticipating Manufacturers and their DISTRIBUTOR'S NAME For domestically manufactured roll your own tobacco list the manufacturer of the tobacco in For roll your own tobacco manufactured outside the United States including foreign GENERAL If more space is required you may copy this form If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 If you purchased any roll your own tobacco from a Nonparticipating Manufacturer BOE 501 CTT Tobacco Schedule T INSTRUCTIONS TOBACCO SCHEDULE T made by manufacturers who did not sign the Master Settlement Agreement (Nonparticipating Manufacturers) mail to Special Taxes and Fees State Board of Equalization 450 N Street MIC:88 P O Box 942879 MANUFACTURED BRANDS manufacturer in column C and the importer of the tobacco in column E only if either the manufacturers of domestic brand name roll your own tobacco list both the nonparticipating must be submitted with your BOE 501 CT Tobacco Products Distributor Tax Return notcolumn C only if they are on the list of Participating Manufacturers Note: Do not list cigarettes cigars little cigars or smokeless tobacco products notforeign manufacturer or the importer is on the list of Participating Manufacturers of the Master Settlement Agreement on the list of Participating Tobacco Manufacturers Brands (for most current list visit PERIOD PREPARATION OF SCHEDULE Products Distributor Tax Return and do not return this schedule Read instructions on back before preparing Retain a copy for your files Sacramento CA 94279 0088 Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at SOLD IN CALIFORNIACNONPARTICIPATING MANUFACTURERNAME AND ADDRESSDNAME AND ADDRESS OF PERSON FROMWHOM EACH BRAND WAS PURCHASEDENAME AND ADDRESS OF FIRSTIMPORTER OF FOREIGN state must file a return on or before the 25th day of the month following the period for which tax is due as part STATE OF CALIFORNIABOARD OF EQUALIZATION TOBACCO SCHEDULE T Under section 30165 1(g)(1) of the Cigarette and Tobacco Products Tax Law every tobacco distributor in this www oag ca gov) You must complete this schedule and include it with your return for the period only if you purchased