CDTFA-1056 (FRONT) REV. 12 (1-18) STATE OF CALIFORNIA VENDOR222S REPORT OF BEER SHIPMENTS INTO CALIFORNIA CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION 037led pursuant to Certi037cate of Compliance IMPORTANT227Read instructions on reverse side before completing report. (a) FOR MONTH OF Year (b) CDTFA ACCOUNT NUMBER (c) Page of Pages (d) NAME (e) MAILING ADDRESS (street, city, state, and zip code) 1 2 3 4 5 6 7 8 NAME OF LICENSED IMPORTER CALIFORNIA CITY/ DESTINATION CDTFA ACCOUNT NUMBER CARRIER NAME OR STEAMSHIP LINE BILL OF LADING R.R. CAR NO. OR TRUCK TRAILER NO. INVOICE PACKAGES TOTAL GALLONS BEERDATE NUMBER NUMBER TYPE 071 -071 -071 -071 -071 -071 -071 -071 -071 -071 -071 -071 -071 -071 -(f) SIGNATURE (g) PRINT NAME AND TITLE (h) TELEPHONE (i) EMAIL ADDRESS American LegalNet, Inc. www.FormsWorkFlow.com CDTFA-1056 (BACK) REV. 12 (1-18) INSTRUCTIONS VENDOR222S REPORT OF BEER SHIPMENTS INTO CALIFORNIA A report must be 037led by each holder of a California Certi037cate of Compliance issued pursuant to section 23671 of the California Alcoholic Beverage Control Act and section 32452 of the Revenue and Taxation Code. The report must be completed in full and mailed to California Department of Tax and Fee Administration, Return Processing Branch, P.O. Box 942879, Sacramento, California 94279-0088 before the 10th day of each month and must show all shipments of beer into California during the preceding calendar month. A report must be 037led even if there are no shipments to report. Pursuant to Revenue and Taxation Code section 32452 failure or refusal of any person to render the reports required under this section is a misdemeanor. PREPARATION OF REPORT For each page, complete the information in boxes (a) through (e) on the top of the report. Enter (a) the month and year of the report; (b) your California Department of Tax and Fee Administration (CDTFA) vendor account number; (c) the page number and the total number of pages of the report; (d) your business name, and (e) your mailing address. Complete boxes (f) through (i) at the bottom of the 037rst page by signing your name in box (f); printing your name and title in box (g); entering your phone number in box (h), and your email address in box (i). If a multiple page report is 037led, boxes (f) through (i) need only be completed on page 1 of the report. Column 1. Enter the name of the licensed importer to whom the shipment is consigned. If the shipment was sold to a person other than to the consignee, show both the name of purchaser and consignee. Note: In reporting pool shipments, list each consignee as a separate shipment. Column 2.Enter the name of the California city to which the shipment is destined. Column 3.Enter the importer222s CDTFA beer and wine importer account number. Column 4.If the shipment entered California via railroad or motor carrier, enter the name of carrier. If the shipment entered California via steamship, enter the name of the steamship line. Column 5.If the shipment entered California via steamship, enter the bill of lading number. If the shipment entered California via railroad, enter the railroad car initials and number. If the shipment entered California via motor carrier, enter the truck trailer number. Column 6.Enter the invoice date and number of the shipment. Column 7.Enter the total number and type of packages contained in the shipment. It is not necessary that quantities be segregated by type and size of container, with the exception of kegs/barrels. Column 8.Enter the total gallons of beer contained in this shipment. Report all beer in gallons by multiplying barrels by 31 (see Revenue and Taxation Code section 32151), or dividing total ounces by 128. Round the result to the nearest gallon. If you need additional information, please contact the California Department of Tax and Fee Administration, Return Processing Branch, P.O. Box 942879, Sacramento, CA 94279-0088. You may also visit the CDTFA website at www.cdtfa.ca.gov or call the Customer Service Center at 1-800-400-7115 (TTY:711); from the main menu, select the option Special Taxes and Fees. Customer service representatives are available weekdays from 8:00 a.m. to 5:00 p.m. (Paci037c time), except state holidays. American LegalNet, Inc. www.FormsWorkFlow.com