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Alaska Alcoholic Beverage Excise Tax Return Form

In Alaska, alcohol beverage enterprises must file this form and pay for the corresponding tax amount by the last day of the month following the month of the sale/consignment of their products.Download

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0405-500  Rev 09/12 - page 1	
EINFor the Month of
Year
SSN
Individual or Corporation Name DOR License Number	
Check if amended return
Check if zero return
Business Name Telephone NumberFax Number
Mailing Address Contact PersonTitle
City StateZip Code Email Address	
Schedule A Tax Calculation	: Enter the information requested below from Schedule B.	
1. GALLONS OF LIQUOR District 1District 2District 3District 4 Total
a Taxable Gallons
b Tax Rate 12.80
c Total Tax (multiply taxable gallons by tax rate)
2. GALLONS OF WINE Total
a Taxable Gallons
b Tax Rate 2.50
c Total Tax (multiply taxable gallons by tax rate)
3. GALLONS OF BEER, MALT BEVERAGES & CIDER Total
a Taxable Gallons
b Tax Rate 1.07
c Total Tax (multiply taxable gallons by tax rate)
4. GALLONS OF BEER & MALT BEVERAGES QUALIFYING FOR REDUCED RATE OF TAX (see instructions) Total
a Taxable Gallons
b Tax Rate 0.35
c Total Tax (multiply taxable gallons by tax rate)
5. IF AMENDED, PREVIOUS AMOUNT PAID
6. TOTAL ALCOHOLIC BEVERAGE TAX DUE (add lines 1c through 4c less line 5)
I declare under penalty of perjury that the information provided in this\
 return, including accompanying schedules and statements, has 
been reviewed by me and to the best of my knowledge and belief is true, \
correct, and complete. 
Signature Printed NameDate	
File and Pay online at www.tax.alaska.gov 	
Due Date: This return must be filed and the tax paid on or before the last day of each calendar month following the month the alcohol was sold or 
consigned into Alaska or removed from a licensed bonded warehouse in Alaska. Submit one return for each licensed facility. 
Required Attachments.  Attach the original copies of all applicable schedules (B,C,D,E and F)\
 and the inventory report (Schedule G)
Payment Information	
Department Use Only PMD  Validation	
DEPARTMENT USE ONLY
ENV
FSN
Mail to:  Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420	
Note: If your liability is $100,000 or more, you must pay using the Onli\
ne Tax Information System (OTIS) at  www.tax.alaska.gov or by wire transfer.
Check if you are remitting by:   	 OTIS confirmation # 	  	  Wire transfer date 
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return

0405-500  Rev 09/12 - page 2	
Schedule B: Gallons Sold in Alaska
Business NameMonth and Year	
Page ______of	 ______
Licensed Location DOR License Number 	
This is a supporting schedule of taxable gallons sold in Alaska to retail establishments and individuals and must accompany 
Schedule A. Each district total and alcohol type total should be reported on Line (a) of sections 1 - 4 of Schedule A and line 
4 of Schedule G, the Inventory Report. Use additional sheets as necessar\
y.	
Number of Gallons	
Name AND Alaska address of taxable sales to 
retailers or individuals (A single line should be 
used to report the total of all individual consumer 
sales)	Judicial 
District  
(destination  of the sale) Liquor
WineBeer, Malt
 Beverages &  Cider Qualified 
Reduced Tax  Rate Beer & 
Malt Beverages 
Totals:
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return

0405-500  Rev 09/12 - page 3	
Schedule C: Gallons Sold to Military Establishments
Business NameMonth and Year	
Page ______of	 ______
Licensed Location DOR License Number	
This is a supporting schedule of tax exempt gallons sold in Alaska to military establishments that meet all requirements for 
tax exempt status as defined in U.S.C. 4-107. The total must be reported on line 5 of Schedule G, the Inventory Report. Use 
additional sheets as necessary. 	
Number of Gallons	
Name AND Alaska address of tax exempt sales to 
Qualified Military Establishments.	
 Judicial 
District  
(destination  of the sale) Liquor
WineBeer, Malt
 Beverages &  Cider	
Qualified 
Reduced Tax  Rate Beer & 
Malt Beverages	
Totals:
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return

0405-500  Rev 09/12 - page 4	
Schedule D: Consigned or Sold to a Licensed Bonded Warehouse in Alaska
Business NameMonth and Year	
Page ______of	 ______
Licensed Location DOR License Number	
This is a supporting schedule of tax exempt gallons consigned or sold to a licensed bonded warehouse in Alaska.  The total 
must be reported on line 6 of Schedule G, the Inventory Report. Use addi\
tional sheets as necessary.	
Number of Gallons	
Name AND Alaska address of tax exempt sales or 
consignments to a Licensed Bonded Warehouse in 
Alaska	Judicial 
District  
(destination  of sale) Liquor
WineBeer, Malt
 Beverages &  Cider	Qualified 
Reduced Tax  Rate Beer & 
Malt Beverages	
Totals:
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return

0405-500  Rev 09/12 - page 5	
Schedule E: Gallons Sold Out of State
Business Name Month and Year	
Page ______of	 ______
Licensed Location DOR License Number	
This is a supporting schedule of tax exempt gallons shipped for sale or consignment out of state.  The total must be reported 
on line 7 of Schedule G, the Inventory Report. Use additional sheets as necessary .	
Number of Gallons
Name AND address of tax exempt sales or consignments 
out of state. Liquor
WineBeer, Malt
 Beverages &  Cider Qualified 
Reduced Tax  Rate Beer & 
Malt Beverages
 	
Totals:
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return

0405-500  Rev 09/12 - page 6	
Schedule F: Distributor’s (Licensed Bonded Warehouses Only) Schedule of Sales of Reduced 
Tax Rate Beer and Malt Beverages
Business NameMonth and Year	
Page ______of	 ______
Licensed Location DOR License Number	
This is a supporting schedule for the Alcoholic Beverage Tax Return. Distributors (Licensed Bonded Warehouses only)  must 
complete this schedule if they sold beer or malt beverages from a brewery approved by DOR for the reduced rate of tax 
provided by AS 43.60.010(c). The amount of qualified reduced tax rate beer and malt beverages sold must agree with the 
totals of qualified reduced tax rate beer and malt beverages reported on Schedules B, C, D and E.  Use additional sheets 
as necessary.
Name AND Address of Qualifying DOR approved Reduced Rate Brewers. Gallons of Qualified Reduced Tax 
Rate Beer & Malt Beverages Sold	
Totals:
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return

0405-500  Rev 09/12 - page 7	
Schedule G: Inventory Report
Business Name For the Month ofYear
Inventory Location DOR License NumberTelephone Number
All Alcoholic Beverage Licensees must complete this form for each licensed l\
ocation.  This form must accompany Schedule A 
regardless of sales activity for the month.  List inventory quantities b\
elow.  Quantity means the total liquid content expressed 
in U.S. gallons, not the number of pallets, cases, bottles or cans which contain alcoholic beverages.  Metric units must be 
converted to U.S. gallons.  For purposes of converting totals, 3.785 liters equals one U.S. gallon.	
Number of Gallons
Liquor WineBeer, Malt      
Beverage & Cider Qualified Reduced 
Tax Rate Beer & Malt Beverages
1 Beginning inventory. Gallons on hand at the beginning of month 
(Should equal the ending inventory from the previous month) *
2 Gallons received or produced during the month
3 Total gallons. Add (Lines 1 and 2)
4 Gallons sold in Alaska (from Schedule B)
5 Gallons sold to military establishments  (from Schedule C)
6 Gallons transferred to a licensed warehouse in Alaska (from 
Schedule D)
7	
Gallons sold out of state (from Schedule E)	
8	Subtotal  (subtract Lines 4 through 7 from Line 3)	
9Increase or (decrease) due to gain or (loss) -
 explain fully 
below
10 Ending inventory  (sum of Line 8 and Line 9)	
Instructions
Line 1 - Beginning inventory should match the reported ending inventory \
from the previous month (* if not, provide explanation)
Line 2 - Report all gallons purchased, manufactured, transferred from ot\
her warehouse locations or returned to this storage location
Line 4 - Report all gallons sold to retailers and individuals in the sta\
te
Line 5 - Report all gallons sold to military establishments 
Line 6 - Report all gallons transferred or sold to a licensed warehouse \
in Alaska 
Line 7 - Report all gallons transferred for sale out of state
Line 8 - Subtract Lines 4 through 7 from Line 3
Line 9 - Enter decrease as a negative number.  Must be fully explained in the “Explanation” box
Line 10 - Ending inventory must equal the beginning inventory for the ne\
xt month	
Explanation:  List each type of (loss) or gain from line 9 (see instructions).
500
500	Alaska
Alcoholic Beverage Excise 
Tax Return	
Alaska
Alcoholic Beverage Excise Tax Return
Next: Alaska Annual Declaration of Anticipated Brewing Form Previous: Alaska Transfer of Cigarette Tax Stamps Form
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