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Get Boe 241a Form

Fore preparing this report. For Month oF ACCoUnt nUMBEr Year Page of Pages BUSInESS ADDrESS (street, city, state and zip code) nAME PURCHASED FROM CITY CODE NO. (BOE use only) A B C INVOICE WINE GALLONS DATE RECEIVED REFERENCE NO. DAtE no. AMoUnt 100 ProoF AnD UnDEr oVEr 100 ProoF D E F G H I J totals from previous page 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TOTALS The original of this report must be mailed to the State Board of Equalization.

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