Form BOE-501-TIM Fillable Tobacco Products Manufacturer/Importer Return of Taxable Distributions of Samples in California
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(1 Samples of snuff (including moist) and chewing tobacco Round cents to the nearest whole dollar WHOLESALE COST $ ) (10 INTEREST $) (10 INTEREST One month's interest is due on tax for each month or fraction of a month that payment is delayed after the due date The adjusted monthly interest rate is ) (11 TOTAL AMOUNT DUE AND PAYABLE (add lines 8 9 and 10) $ ) (1A Total wholesale cost of nontaxable transactions reported on BOE 501 MIT column H $) (2 Samples of pipe tobacco WHOLESALE COST $ ) (3 Samples of cigars WHOLESALE COST $ ) (4 Samples of roll your own WHOLESALE COST $ ) (5 Other Samples (Please provide description of other tobacco product samples in the space provided ) ) (6 Total distributions subject to tax (add wholesale cost lines 1 through 5) WHOLESALE COST $ ) (7 Tax Rate) (8 Total amount of tax due (multiply line 6 by line 7) $ ) (9 PENALTY [multiply line 8 by 10% (0 10) if payment is made after due date shown above] $ ) (BOE USE ONLY ) (CLEAR) CLEAR (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (Other Samples WHOLESALE COST $ ) (PRINT NAME AND TITLE) (PRINT) PRINT (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (YOUR ACCOUNT NO ) [ FOID ] 1 800 400 7115 (TTY:711); from the main menu select the option Special Taxes and Fees 10 INTEREST: One month's interest is due on tax for each month or fraction of a month that payment is 11 TOTAL AMOUNT DUE AND PAYABLE (add lines 8 9 and 10) $ 1A Total wholesale cost of nontaxable transactions reported on BOE 501 MIT 2 Samples of pipe tobacco $ 3 Samples of cigars $ 4 Samples of roll your own $ 5 Other Samples (Please provide description of other tobacco product samples in the space 6 Total distributions subject to tax (add wholesale cost lines 1 through 5)$ 7 Tax Rate 8 Total amount of tax due (multiply line 6 by line 7) $ 9 Penalty [multiply line 8 by 10% (0 10) if payment is made after due date shown above] $ Always write your account number on your check or money order Make a copy of this document for your records and 10 additional amounts are due for penalty and interest charges The penalty is ten percent (0 10) of the amount of BEFORE PREPARING BOARD OF EQUALIZATION BOE 501 TIM (BACK) REV 5 (4 13) BOE 501 TIM (FRONT) REV 5 (4 13) column H $ COST1 Samples of snuff (including moist) and chewing tobacco $ Custom's Taxes paid DEFINITIONS delayed after the due date The adjusted monthly interest rate is Detail of nontaxable transactions shall be furnished to the BOE on BOE 501 MIT distribution and each package of sample tobacco products distributed shall be clearly marked as a sample With the exception of Distributor includes every person who makes a "distribution" of tobacco products or who sells or accepts orders for DUE ON OR BEFORE EMAIL ADDRESS Every person that manufactures or imports tobacco products shall file this tax return on or before the 25th day of the month examined by me and to the best of my knowledge and belief is a true correct and complete return FILING REQUIREMENTS following the month for which the tax is due The giving away in this state of untaxed tobacco products as samples is a taxable For example the wholesale cost of any manufactured tobacco product that is distributed in a taxable manner shall GENERAL I hereby certify that this return including any accompanying schedules and statements has been If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 Importer means any purchaser for resale in the United States of cigarettes or tobacco products manufactured outside of In addition to the price paid for the tobacco product the wholesale cost of any tobacco product that is imported into this include all manufacturing costs the cost of raw material including waste materials not incorporated into the final product includes the distribution of untaxed tobacco products as samples by a manufacturer/importer or its agents or representatives Line 11 Amount Due Enter the total amount due and payable including penalty and interest if applicable line 1A below the return should only include taxable distributions of sample tobacco products Line 1A Total Wholesale Cost of Untaxed Tobacco Products Enter the total wholesale cost of nontaxable tobacco Lines 1 Wholesale Cost of All Tobacco Products Distributed Enter the total wholesale cost as defined of sample Lines 9 Payment After Due Date If you are paying the tax after the due date shown on the front of this return Make check or money order payable to State Board of Equalization Manufacturer means a manufacturer of cigarettes and tobacco products sold in this state month or portion of a month after the due date nearest whole dollar OF TAXABLE DISTRIBUTIONS OF SAMPLES IN CALIFORNIA other articles or products made of or containing at least fifty percent (0 50) tobacco; but does not include cigarettes Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go PO BOX 942879 PRINT NAME AND TITLE products Sales of tobacco products [pursuant to Revenue and Taxation Code sections 30103 and 30105] products sold from form BOE 501 MIT column H provided ) READ INSTRUCTIONS Return RETURN PREPARATION Round cents to the SACRAMENTO CA 94279 0056 Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at section 30008] of tobacco products shall be reported on BOE 501 CT Tobacco Products Distributor Tax shall be reported on BOE 501 MIT All other taxable distributions [pursuant to Revenue and Taxation Code SIGNATURE SPECIAL TAXES AND FEES state directly from outside the country shall include any Federal Excise or US Custom's Taxes paid STATE OF CALIFORNIA Tax Law The law imposes a tax upon the distribution of tobacco products based on the wholesale cost of these products This tax owing The interest rate for late payment is noted on line 10 on the front of this form and applies for each TAXABLE DISTRIBUTIONS OF SAMPLES IN CALIFORNIA TELEPHONE The California State Board of Equalization (BOE) is responsible for administering the California Cigarette and Tobacco Products the cost of labor any direct and indirect overhead costs the wholesale markup and any Federal Excise and/or US The tax rate is determined annually by the BOE and is equivalent to the combined rate of tax imposed on cigarettes the United States for the purpose of making a first sale or distribution within the United States thru 5 tobacco products that you distributed The return should include only taxable distributions of sample tobacco to our website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card go to our website or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail Tobacco Products include but are not limited to all forms of cigars smoking tobacco chewing tobacco snuff and any TOBACCO PRODUCTS MANUFACTURER/IMPORTER RETURN TOBACCO PRODUCTS MANUFACTURER/IMPORTER RETURN OF tobacco that are to be transported from outside California to a consumer within California value of any manufacturer's discounts or trade allowances (Revenue and Taxation Code section 30017 and 30123) WHOLESALE Wholesale Cost means the cost of tobacco products and samples including the dollar value of samples and the dollar YOUR ACCOUNT NO your return