Alaska Annual Declaration of Anticipated Brewing Form
To avail of the reduced tax rate, the applicant must ensure that the State of Alaska’s Department of Revenue receives this form by May 31 (every year). Specifically, this form must be mailed to this address:Download
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0405-406 Rev 09/12 - page 1 Website: www.tax.alaska.gov Email: [email protected] Phone: 907-269-6620 Fax: 907-269-6644 SignatureDate Printed Name Printed Title EINTTB Registry #: SSN Business Name DBA (if applicable) Mailing Address Physical Address of Brewery Mailing City StateZip Physical City StateZip Contact Email Address Contact TelephoneFAX Number Physical Telephone July 1, _______ to June 30, _______ To qualify for the Alaska reduced rate tax, this form MUST be received on or before May 31 each year. Type of Entity (check one) : Individual Partnership Corporation Limited Liability Corporation Other __________________ Please answer all of the questions below 1. Have you included a copy of your most recent Brewer’s Report of Operations (TTB F5130.09) dated in the current calendar year? Yes No 2. Has this brewery exceeded the 2 million barrel limit as set forth in 26 \ USC 5051(a)(2)? Yes No 3. Will this brewery ship to or sell more than 60,000 barrels in Alaska in the fiscal year July 1 to June 30? Yes No 4. Does this brewery operate more than one brewery? Yes No 5. Is this brewery a member of a controlled group of brewers? Yes No If you are a member of a controlled group of brewers, or you operate more than one brewery, include a list of the names and addresses of the other breweries and the TTB Registry Number for each below. If more space is needed please attach a separate sheet. Member Brewery Name (dba) Physical AddressCityStateTTB Registry Number I will allow the Alaska Department of Revenue to disclose to the following Alaska Alcoholic Beverage Distributor that the above named breweries qualify for the reduced rate of tax as provided by AS 43.60.010(c) and in the event that sales of beer produced by the above named breweries meet or exceed 60,000 barrels in Alaska during the fiscal year (July 1 to June 30), I allow the Alaska Department of Revenue to inform the following distributor of the volume of beer sold in Alaska prior to meeting or exceeding 60,000 barrels so the distributor may have time to adjust the sales price to account for the increase in tax. I also agree to a\ llow the Alaska Department of Revenue to publish our status as a reduced rate brewer on the department\ ’s website. Distributor’s Name Distributor’s Address Signature of Owner or other Authorized Representative of the Brewery. I certify that I have the authority to execute this document on behalf of the brewery. I declare under penalty of perjury that this document has been examine\ d by me and, to the best of my knowledge and belief, is true, correct and complete. Mail to: Alaska Department of Revenue, 550 W 7th Ave STE 500, Anchorage AK 99501-3555 Alaska Annual Declaration of Anticipated Brewing 406406 0405-406 Rev 09/12 - page 2 Please list the brand names of all products your brewery intends to ship to or sell in Alaska and include the percentage of alcohol by volume for each product. Attach additional sheets as necessary. Product Brand Name Percentage of Alcohol by Volume (ABV) Page _____ of _____ Alaska Annual Declaration of Anticipated Brewing 406406
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