Form BOE-501-CW Fillable Cigarette Wholesaler's Report

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([ FOID ]) (1 Inventory first of month) (2 Purchased during month (enter total from Part 2 on reverse)) (3 Other acquisitions (transfers returns etc )) (4 Total cigarettes to account for (add lines 1 through 3)) (5 Deduct: Inventory end of month (last physical inventory date )) (6 Deduct: Other dispositions (destroyed stolen lost etc )) (7 Total deductions (add lines 5 and 6)) (8 TOTAL SALES DURING MONTH (subtract line 7 from line 4)) (BOE USE ONLY ) (button) CLEAR (button) PRINT (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CARTONS OF CIGARETTES ) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (CITY) (DATE ) (DUE ON OR BEFORE) (I hereby certify that this return including any accompanying schedules and statements has been examined by me and to the best of my knowledge and belief is a true correct and complete return EMAIL ADDRESS) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (INVOICE NUMBER) (PRINT NAME AND TITLE) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (PURCHASED FROM (NAME)) (ROW 1 DATE ) (ROW 10 DATE ) (ROW 11 DATE ) (ROW 12 DATE ) (ROW 13 DATE ) (ROW 14 DATE ) (ROW 15 DATE ) (ROW 16 DATE ) (ROW 17 DATE ) (ROW 18 DATE ) (ROW 19 DATE ) (ROW 2 DATE ) (ROW 20 DATE ) (ROW 21 DATE ) (ROW 22 DATE ) (ROW 23 DATE ) (ROW 24 DATE ) (ROW 3 DATE ) (ROW 4 DATE ) (ROW 5 DATE ) (ROW 6 DATE ) (ROW 7 DATE ) (ROW 8 DATE ) (ROW 9 DATE ) (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (text) (TOTAL (enter on Part 1 line 2) CARTONS OF CIGARETTES ) (YOUR ACCOUNT NO ) [ FOID 2 Purchased during month (enter total from Part 2 on reverse) 3 Other acquisitions (transfers returns etc ) 4 Total cigarettes to account for (add lines 1 through 3) 5 Deduct: Inventory end of month (last physical inventory date ) 6 Deduct: Other dispositions (destroyed stolen lost etc ) 7 Total deductions (add lines 5 and 6) 8 TOTAL SALES DURING MONTH (subtract line 7 from line 4) 800 400 7115 (TTY: 711); from the main menu select the option Special Taxes and Fees BOARD OF EQUALIZATIONSPECIAL TAXES AND FEESP O BOX 942879SACRAMENTO CA 94279 2074 BOE 501 CW (BACK) REV 6 (3 11) BOE 501 CW (FRONT) REV 6 (3 11) CIGARETTE WHOLESALER'S RETURN cigarettes on hand is required to be taken not less often than at three month intervals CITYCARTONS OFCIGARETTES DATEINVOICENUMBERPURCHASED FROM(NAME) DUE ON OR BEFORE EMAIL ADDRESS Explain fully the entries on lines 3 and 6 FILING REQUIREMENTS from other wholesalers etc A full explanation of the cigarettes entered on this line should be made in the space I hereby certify that this return including any accompanying schedules and statements has beenexamined by me and to the best of my knowledge and belief is a true correct and complete return If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 invoices shown on Part 2 of this return Line 1 Enter your cigarette inventory at the beginning of the month Line 2 Enter the total cigarette purchases for the month This total must agree with the total of the detail listing of purchase Line 3 Enter other acquisitions of cigarettes such as cigarettes returned from a sale made during a prior month transfers Line 5 Enter the inventory at the end of the month and show the date of the last physical inventory A physical inventory of Line 6 This line is reserved to include other dispositions of cigarettes such as losses by theft fire or other damage and Line 8 The entry on this line should agree with your record of cigarette sales for the calendar month being reported must be retained on the licensed premise for verification by State Board of Equalization auditors of the entry on this line must be made in the space reserved for this purpose or on an attached sheet of paper or her cigarette inventory Complete and accurate records of all transactions in cigarettes and a duplicate of this return PART 1 CIGARETTE STOCK SUMMARYCARTONS OFCIGARETTES1 Inventory first of month PART 2 PURCHASES OF CIGARETTES PRINT NAME AND TITLE READ INSTRUCTIONSBEFORE PREPARING reserved for this purpose or on an attached supplemental sheet Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at shall file a return on or before the 25th day of the month following the monthly reporting period showing the activity in his SIGNATURE STATE OF CALIFORNIABOARD OF EQUALIZATION TELEPHONE( This return must be signed Make a copy of this document for your records TOTAL (enter on Part 1 line 2) transfers to other wholesalers etc which might not be classified as sales As in the case of line 3 a full explanation Under section 30188 of the Cigarette and Tobacco Products Tax Law every licensed cigarette wholesaler in this state YOUR ACCOUNT NO

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