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Alaska Cigarette and Tobacco Products Monthly Tax Return Form

In Alaska, cigarette and tobacco companies must file this form by the last day of the month following the month of manufacture/import/acquisition of their most recent batch of products.Download

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0405-522  Rev 09/12 - page 1	
DUE DATE:	 The last day of the month following the month in which cigarettes and to\
bacco products 	 	
were manufactured, imported, acquired or sold or in which tax stamps wer\
e purchased.	
EIN	License Number	Period Ending (yyyymm)	AK Business License Number	
SSN
Name 	Telephone Number 	Fax Number 	
Mailing Address 	Contact Person	Contact Telephone	
City 	State	ZIP + 4 	Contact Email	
Schedule A - Payment Due for Cigarette Tax Stamps
1	Cigarette tax due on the purchase of cigarette tax stamps for the month.\
 From Schedule E, line 7, column (b)	1	
2	Less stamp discount from Schedule H or I	2	(                   )	
3	Less cigarette tax stamp credits from Schedule J, line 19	3	(                   )	
4	Cigarette tax paid with stamp order.  From Schedule E, line 7, column (c)	4	(                   )	
5	Cigarette tax due (overpaid) with this return.  Subtract lines 2, 3 an\
d 4 from line 1 (see instructions)	5	
Schedule B - Tobacco Products Excise Tax Liability	(Total carried forward from Schedule G)	
6	Wholesale price of tobacco products manufactured, imported, acquired or \
sold during the month 	6	
7	Less military sales (see instructions)	7	()	
8	Less Indian sales - Metlakatla Indian Reservation or Klawock Smoke Shop \
(see instructions)	8	()	
9	Less other credits (see instructions) 	9	()	
10	Total wholesale price of tobacco products manufactured, imported, acquire\
d or sold. Subtract 
lines 7 through 9 from line 6	10	
11	Tax @75% of wholesale price. Multiply line 10 by .75	11	
12	Less .4% commission for expense of tobacco products tax collections. Mul\
tiply line 11 by .004	12	()	
13	Total tobacco products excise tax due. Subtract line 12 from line 11	13	
14	Total cigarette and tobacco products tax due (overpaid). Add line 5 and 13	14	
15	Amended returns only.	 Cigarette and tobacco products tax previously paid for this month	15	()	
16	Total amount due (overpaid). 	Subtract line 15 from line 14. If line 16 shows tax due, 	 	payment must be remitted by the due date of the return  to avoid a late \
payment penalty.	16	
I declare under penalty of perjury that this return, including all accompanying scheduling and invoices, has been examined by me and to the best of my knowledge and belief is a true, correct and complete return.
Signature of Taxpayer	Date	
Printed Name	Printed Title	
Electronic Payment Information	
Department Use Only PMD	Validation	
Alaska
Cigarette and Tobacco Products 
Monthly Tax Return	
DEPARTMENT USE ONLY
ENV
FSN	
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 paying by:   	 OTIS confirmation # 	  	  Wire transfer date 	
Check here if you have been approved to purchase cigarette tax stamps under a deferred payment plan	Check here if no activity for the month. Sign and date below
Check if amended return and attach explanation  
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0405-522  Rev 09/12 - page 2	
Alaska Report of Out-of-State Sales of Cigarettes
Complete a separate form for each state in which cigarettes were sold
Federal ID                 	License Number 	Name of Licensee	
Physical location in Alaska from where cigarettes were shipped
Address 
City 	State	ZIP+4	Contact Telephone	
This schedule must be attached to the Alaska Cigarette and Tobacco Products Monthly Tax Return, Form 522.  Use this schedule to report 
stamped and unstamped cigarettes sold outside of Alaska. A cigarette licensee may maintain unstamped cigarettes in Alaska and/or claim 
a credit for Alaska stamped cigarettes if its business includes sales to customers ou\
tside of Alaska and the licensee is properly licensed 
in the state where the cigarettes are sold.
Cigarettes transferred or sold into (list state)
Are you licensed in the state where cigarettes were sold or transferred?\
          	  Yes        	 No	License Number	
Column descriptions1.  Date of shipment or transfer out of state.    
2. Indicate how shipped:  DT (Distributor Transport); 	 	
CC (Common Carrier);  CT (Customer Transport).     	
3.  Invoice number of product shipped into another state.   
4.  Complete name, address and city of company or person to 	
whom cigarettes were sold.	
5.  Number of packages of 20 cigarettes per pack.
6.  Number of packages of 25 cigarettes per pack.
7.  The total number of sticks per invoice.
8. Indicate if you paid tax to the state where the cigarettes were 	
shipped.	
9. Indicate whether cigarettes were affixed with the Alaska tax 	
stamp.  If yes, complete Schedule J to claim a credit.	
(1)Date shipped	
(2)	Shipping method	
(3)Invoice number 	
(4)	Name  and Address 	(5)	# of Packs 	20s	
(6)	# of Packs 	25s	
(7)	# of Cigarettes (total sticks)	
(8)Tax paid (yes/no)	
(9)	Affixed with AK tax stamp?(yes/no)	
Schedule C
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0405-522  Rev 09/12 - page 3	
Alaska Cigarette Tax Stamp Inventory Report
For tax stamps purchased at the current tax rate of $.10 per Cigarette
This schedule must be attached to the Alaska Cigarette and Tobacco Products Monthly Tax Return, Form 522.  All licensees must complete 
this form for each location where cigarette tax stamps are located, both within and outside the state.  Ending inventory should only include 
tax stamps 	not 	affixed to cigarette packages. Use this schedule to report tax stamps purchased at the current tax rate of $.10 per cigarette 	
for PM cigarettes and $.1125 per cigarette for NPM cigarettes. See instructions for definitions of PM and NPM cigarettes. Use Schedule D-2 	
Stamp Denomination 	
Cigarette Tax Stamp Inventory	
(a)	20 PM cigarettes	(b)	25 PM cigarettes	(c)	20 NPM cigarettes	
1	Number of cigarette tax stamps on hand at beginning of the month.  From line 7 of the previous month’s Schedule D-1	1	
2	Number of cigarette tax stamps purchased during the month.  From Form 620, line 3	2	
3	Number of cigarette tax stamps transferred in during the month.  From Form 622, Part III	3	
4	Number of cigarette tax stamps transferred out during the month.  From Form 622, Part III	4	(                                 )	(                     )	(                       )	
5	Number of cigarette tax stamps affixed to cigarette packages during the month	5	(                     )	(                     )	(                       )	
6	Number of unused cigarette tax stamps returned for a refund during the month.  From Schedule J, Part I, Column B	6	(                     )	(                     )	(                       )  	
7	Number of cigarette tax stamps on hand at end of the month. Line 1 plus lines 2 and 3 minus lines 4 through 6	7	
8	Value of each tax stamp unfixed to cigarette packages	8	$2.00	$2.50	$2.25	
9	Value of ending cigarette tax stamp inventory.  Multiply line 7 by line 8	9	
Alaska Cigarette Tax Stamp Purchase and Payment Record
Complete the following purchase and payment record for cigarette tax stamp orders you made during the month covered by this return.  
Enter the date of the order in column (a), the dollar amount of total stamps ordered from line 6 of Form 620 in column (b) and the amount 	
(a)Date of order	
(b)Dollar amount ordered	
(c)Amount paid with order	
1	From Form 620, Cigarette Tax Stamp Order Form	1	
2	From Form 620, Cigarette Tax Stamp Order Form	2	
3	From Form 620, Cigarette Tax Stamp Order Form	3	
4	From Form 620, Cigarette Tax Stamp Order Form	4	
5	From Form 620, Cigarette Tax Stamp Order Form	5	
6	Carry forward from attached sheets	6	
7	Total cigarette tax stamp purchases and payments.  Add lines 1 through 6 in columns (b) and (c). Enter amount in column (b) on Schedule A, line 1 and amount in column (c) on Schedule A, line 4	7	
Federal ID            	License Number	Name of Licensee	
Physical location in Alaska from where cigarettes were shipped
Address	 	Name of Contact Person	
City	 	State	ZIP + 4	Contact Telephone	
Schedule E
of payment made at the time of purchase from line 7 of Form 620 in column (c). Do not include 
payments made under a deferred payment plan in column (c). Attach a separate sheet if more 
than 5 orders were made during the month.
for tax stamps purchased at the prior tax rate of $.09 per cigarette for\
 PM cigarettes and $.1025 per cigarette for NPM cigarettes.
Schedule D-1  
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0405-522  Rev 09/12 - page 4	
Invoice date 	Name of supplier or purchaser	Invoice number 	Number of cigarettes	
TOTALS CARRIED FORWARD FROM PREVIOUS PAGE(S)	
Total
Alaska Cigarette Transactions
Do not report other tobacco products here. Use Schedule G to report othe\
r tobacco products.
Federal ID	License Number	Name of Licensee	Period Ending (yyyymm)	
You must complete this schedule if you manufactured, imported, acquired or sold cigarettes in the state during the month covered by this 
return.  Use  a  separate  schedule  for  each  type  of  transaction  that  applies  to  your  business  identified  in  boxes A  through  E  below.    Use 
additional pages as necessary. All invoices supporting transactions identified in boxes A through E must be attached to this schedule to 
constitute a complete filing.	
Page number	 	
_______	of_______ 	
 	
Schedule F
Check one:	A.	Cigarettes manufactured, imported, acquired or sold	
B.	Cigarettes sold to military	
C.	Cigarettes sold to Metlakatla Indian Reservation or Klawock Smoke Shop	
D.	Unstamped cigarettes returned to manufacturer. You must attach an affidavit from the manufacturer supporting the number of cigarettes returned. Do not report the return of 	stamped	 cigarettes on this schedule. Use Schedule J.	
E.	Unstamped  cigarettes  destroyed. You  must  attach  U.S. Treasury  Department  Form ATF-F  5200.7  or  certification from the manufacturer attesting to the destruction. Do not report the destruction of 	stamped	 cigarettes on this 	schedule. Use Schedule J.
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Cigarettes Only

0405-522  Rev 09/12 - page 5	
Invoice date 	Name of supplier or purchaser	Invoice number 	Tobacco products only	
TOTALS CARRIED FORWARD FROM PREVIOUS PAGE(S)	
Total
Federal ID	License Number	Name of Licensee	Period Ending (yyyymm)	
Alaska Tobacco Products Transactions
Do not report cigarettes here. Use Schedule F to report cigarettes.
You must complete this schedule if you manufactured, imported, acquired o\
r sold tobacco products (other than cigarettes) in the state 
during the month covered by this return.  Use a separate schedule for each type of transaction that applies to your business identified in 
boxes A through D below.  Use additional pages as necessary.  All invoices supporting transactions identified in boxes A through D must 
be attached to this schedule to constitute a complete filing.	
Page number
_______	of_______ 	
 	
Schedule G
Check one:	A.	Tobacco products manufactured, imported, acquired or sold.  Enter on Sche\
dule B, line 6.	
B.	Credit for military sales. Enter on Schedule B, line 7.	
C.	Credit for	 Metlakatla Indian Reservation or Klawock Smoke Shop sales.  	Enter on Schedule B, line 8.	
D.	Other credits - Unsaleable or destroyed tobacco products.  You must attach an affidavit from the manufacturer or 
distributor supporting the amount of tobacco products returned and/or U.S. Treasury Dept. Form ATF-F 5200.7 
supporting the amount of tobacco products destroyed.  Enter on Schedule \
B, line 9.  
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Tobacco Products Only

0405-522  Rev 09/12 - page 6	
Federal  ID	License Number	Name of Licensee	Period Ending (yyyymm)	
Alaska Cigarette Tax Stamp Discount - Unaffiliated Licensee
This is a supporting schedule for Alaska Cigarette and Tobacco Products Monthly Tax Return, Form 522.  If you are 	not 	affiliated  with  any 	
other Alaska cigarette and tobacco products tax licensee or you are filing a consolidated return that includes all affiliated licensees, use this 
worksheet to calculate the discount allowed on stamp purchases made during the month covered by this return. If you are affiliated with any 
other Alaska cigarette and tobacco products tax licensee and you and any of your affiliates file separate returns, you must use Schedule I to 
calculate your discount. The discount is equal to the sum of the amounts calculated using the fol\
lowing percentages of denominated value of 
stamps purchased by a licensee under this section in a calendar year:  (\
1) $1,000,000 or less, three percent; (2) the amount that is more than 
$1,000,000 but not more than $2,000,000, two percent; (3) the amount t\
hat is more than $2,000,000, zero percent.
1	Total stamp purchases for the month covered by this return. From Schedul\
e E, line 7, column (b)	1	
2	Less credit for unused stamps and stamped cigarettes returned to manufac\
turer or destroyed. From line 
22 of Schedule J	2	(                       )	
3	Total current stamp purchases less credits.  Subtract line 2 from line 1	3	
4	Total purchases from Schedule H, line 5 of your last stamp discount worksheet that represent 
accumulated stamp purchases for the year beginning January 1	4	
5	Total year-to-date stamp purchases. Add lines 3 and 4	5	
6	
If line 4 is more than $2,000,000, you are not entitled to a discount. Enter zero here and on line 2 of 
Schedule A.  You are done computing your discount. If line 4 is less than $2,000,000, leave line 6 blank 
and continue to line 7	
6	
7	 If the amount on line 5 is $1,000,000 or less, multiply 	line 3 	by 3% (.03).  Enter here and on line 2 of 	
Schedule A	7	
You are done computing your discount. Stop here.	
-or-	
8	If line 5 is more than $1,000,000 and line 4 is $1,000,000 or less, comp\
lete lines 8a through 9
a	Discount base	8a	$1,000,000	
b	Amount from line 4	8b	(                           )	
c	Subtract line 8b from line 8a 	8c	
d	Multiply line 8c by 3% (.03) 	8d	
e	Amount from line 3	8e	
f	Amount from line 8c	8f	
g	Subtract line 8f from line 8e	8g	
h	Enter the smaller of line 8g or $1,000,000	8h	
i	Multiply line 8h by 2% (.02)	8i	
9	Add lines 8d and 8i enter here and on line 2 of Schedule A	9	
10	If line 5 is more than $1,000,000 and line 4 is more than $1,000,000 and\
 less than $2,000,000 complete lines 10a through 11
a	Discount base	10a	$2,000,000	
b	Amount from line 4	10b	(                  )	
c	Subtract line 10b from line 10a	10c	
d	Enter the smaller of line 10c or line 3	10d	
e	Multiply line 10d by 2% (.02)	10e	
11	Enter the amount from line 10e here and on line 2 of Schedule A	11	
You are done computing your discount. Stop here.	
-or-	
Schedule H
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0405-522  Rev 09/12 - page 7	
Alaska Cigarette Tax Stamp Discount - Affiliated Licensee
Federal ID	License Number	Name of Licensee	Period Ending (yyyymm)	
This is a supporting schedule for Alaska Cigarette and Tobacco Products Monthly Tax Return, Form 522.  If you are affiliated with any other Alaska cigarette and tobacco products tax licensee and you and any of your affiliates file separate returns, use this worksheet to calculate the discount allowed on stamp purchases made during the month covered by this return.  If you are not affiliated with any other Alaska cigarette and tobacco products tax licensee or you are filing a consolidated return that includes all affiliated licensees, you must use Schedule H to calculate your discount.  The discount is equal to the sum of the amounts calculated using the following percentages of denominated value of stamps purchased by a licensee under this section in a calendar year: (1) $1,000,000 or less, three percent; (2) the amount that is more than $1,000,000 but not more than $2,000,000, two percent; (3) the amount that is more than $2,000,000, zero percent.
1 	Total stamp purchases for the month covered by this return.  From Schedul\
e E, line 7, column (b)	1	
2	Less credit for unused stamps and stamped cigarettes returned to manufac\
turer or destroyed. From line 22 of Schedule J	2	(                           )	
3	Total current stamp purchases less credits. Subtract line 2 from line 1	3	
4	Total current stamp purchases less credits of affiliated licensees. From line 3 of Schedule I of all affiliated licensees for the month covered by this return	4	
5	Total current stamp purchases of affiliated group of licensees. Add lines 3 and 4	5	
6	Total purchases from Schedule I, line 7 of your last stamp discount worksheet that represent accumulated \
stamp purchases of the affiliated group of licensees for the year beginning January 1	6	
7	Total calendar year-to-date purchases of affiliated group of licensees.  Add lines 5 and 6	7	
8	If line 6 is more than $2,000,000, you are not entitled to a discount. Ente\
r zero here and on line 2 of Schedule A.  	 	You are done computing your discount. If line 6 is less than $2,000,000, leave line 8 blank and continue to line 9	8	
9	If the amount on line 7 is $1,000,000 or less, multiply	 line 3	 by 3% (.03).  Enter here and on line 2 of Sched	-	ule A	9	
You are done computing your discount. Stop here.	-or-	
10	If line 7 is more than $1,000,000 and line 6 is $1,000,000 or less, comp\
lete lines 10a through 11
a	Discount base	10a	$1,000,000	
b	Amount from line 6	10b	(                     )	
c	Subtract line 10b from line 10a	10c	
d	Divide line 3 by line 5 	10d	
e	Multiply line 10d by line 10c	10c	
f	Multiply line 10e by 3% (.03)	10f	
g	Amount from line 3	10g	
h 	Amount from line 10e	10h	
i 	Subtract line 10h from line 10g	10i 	
j	Enter the smaller of line 10i or $1,000,000	10j	
k	Multiply line 10j by 2% (.02)	10k	
11	Add lines 10f and 10k enter here and on line 2 of Schedule A	11	
12	If line 7 is more then $1,000,000 and line 6 is more than $1,000,000 and\
 less than $2,000,000
a	Discount base 	12a	$2,000,000	
b	Amount From line 6	12b	
c	Subtract line 12b from line 12a	12c	
d	Divide line 3 by line 5 	12d	
e	Multiply line 12d by line 12c	12e	
f	Enter the smaller of line 12e or line 3 	12f	
g	Multiply line 12f by 2% (.02)	12g	
13	Enter the amount from line 12f here and on line 2 of Schedule A	13	
You are done computing your discount. Stop here.	-or-	
Schedule I  
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0405-522  Rev 09/12 - page 8	
Alaska Cigarette Tax Stamp Credits
Federal ID	License Number	Name of Licensee	Period Ending (yyyymm)	
This is a supporting schedule for Alaska Cigarette and Tobacco Products Monthly Tax Return, Form 522.  Use this form to claim a credit for unused cigarette tax stamps returned to the Tax Division and for cigarette tax stamps affixed to packages of cigarettes returned to the manufacturer, sold to customers outside of Alaska or destroyed.  A credit will not be given unless the required documentation is attached to the schedule.
Part I - Credit for unused cigarette tax stamps returned to Tax Division.Stamps must be received by the Tax Division before a credit will be given (see instructions).	
Stamp serial #s(required)	
Stamp	denomination	(A)	
# of stamps returned 	(B)	Stamp value	(C)	Stamp color(description)	
Value of stamps	returned 	(multiply B x C)	
20	$1.80	blue	1	
25	$2.25	gray	2	
20	$2.05	tan (NPM cigs)	3	
20	$2.00	white	4	
25	$2.50	brown	5	
20	$2.25	yellow (NPM cigs)	6	
Credit for stamps returned to or destroyed by the Tax Division. Add lines 1 through 6 and enter here	7	
Part II - Credit for stamped cigarettes returned to manufacturer, destroyed or restamped.Attach certification from the manufacturer for returned cigarettes or other preapproved documentation attesting to the destruction  (see instructions).	
Stamp serial #s(required)	
Stamp	denomination	(A)	
# of packages	returned 	(B)	Stamp value	(C)	Stamp color(description)	
Value of stampsreturned/destroyed (multiply B x C)	
20	$1.80	blue	8	
25	$2.25	gray	9	
20	$2.05	tan (NPM cigs)	10	
20	$2.00	white	11	
25	$2.50	brown	12	
20	$2.25	yellow (NPM cigs)	13	
Credit for stamped cigarettes returned to manufacturer, destroyed or restamped. Add lines 8 through 13 and enter here	14	
Part II - Credit for stamped cigarettes exported outside of Alaska for saleComplete schedule C for each state where cigarettes were sold.	
Stamp serial #s	(required)	
Stamp 	denomination	(A)	
# of packages 	exported 	(B)	Stamp Value	(C)	Stamp color(description)	
Value of stamps	exported	(multiply B x C)	
20	$1.80	blue	15	
25	$2.25	gray	16	
20	$2.05	tan (NPM cigs)	17	
20	$2.00	white	18	
25	$2.50	brown	19	
20	$2.25	yellow (NPM cigs)	20	
Credit for stamped cigarettes exported outside of Alaska for sale. Add lines 15 through 20 and enter here	21	
Part IV - Total credit for cigarette tax stamps returned, destroyed or exported out\
side Alaska. Add the amounts on lines 7, 14 and 21. Enter here and on line 3 of Schedule A  and line 2 of Schedule H or I	22	
Schedule J
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Next: Alaska Commercial Passenger Vessel Excise Tax Monthly Return Form Previous: Alaska Annual Declaration of Anticipated Brewing Form
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