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Alaska Commercial Passenger Vessel Excise Tax Monthly Return Form

Every month, party providing transportation services via a commercial passenger vessel must file this form with Alaska’s Department of Revenue.Download

Extracted Text for Proper Search

0405-210 Rev 10/12 - page 1	
Pay online at www.tax.alaska.gov  
or make check payable to  State of Alaska
Electronic Payment Information
Note: if your liability exceeds $100,000 you must pay using the Online Tax Information System (OTIS) at	 www.tax.alaska.gov or by wire transfer.
Check if you are paying by:  	
 OTIS (confirmation # ____________________________)  	  Wire Transfer (date _____________)
I declare under penalty of perjury that the information provided in this\
 return, including all accompanying schedules and statements, has 
been reviewed by me and to the best of my knowledge and belief is true, \
correct and complete.
Signature of Taxpayer Date
Print Name Print Title	
DEPT USE ONLY
PMD VALIDATION	
Due Date: Last day of the month following the month in which voyages wer\
e completed.	
Schedule A – Commercial Passenger Vessel Excise Tax Calculation
1. Total number of passengers (total from Schedule B)
1
2. Tax rate 2	
$34.50	
3. Tax (multiply line 1 by the tax rate on line 2)3
4. Tax Reduction for Local Levies (total from Schedule D) 4(                                     )
5. Total tax (line 3 less line 4) 5
6.
 AMENDED RETURNS ONLY	 - amount previously paid with originally filed return 6
(                                     )
7. Total amount due (overpaid) (line 5 less line 6) 7	
Alaska
Commercial Passenger Vessel Excise Tax
Monthly Return	
 	
Department Use Only
Envelope
FSN	
 	 EIN 
   SSN Vessel Call Sign
Period Ending (year/month)	 Check if amended return and 
attach explanation 
Taxpayer Name  Vessel Name 
Mailing Address  Contact Person 
City  StateZip Code Contact Phone  Fax Number
Country (if other than U.S.) Contact  Email Address 	
You can file this return and pay on-line using the Online Tax Information System (OTIS) at www.tax.alaska.gov 	
Mail to:  Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420  
210 
210

0405-210 Rev 10/12 - page 2	
Taxpayer NameVessel NamePeriod Ending (year/month)	
Alaska Port Codes
Anchorage ANC
Dutch Harbor/Unalaska DH
Haines HNS
Homer  HOM
Juneau JNU
Ketchikan KTN
Kodiak KDK
Metlakatla  MET
Nome NOM
Petersburg PTB
Point Sophia/Icy 
Straits/Hoonah PTS
Seward  SEW
Sitka SIT
Skagway  SKG
St. Matthew  STM
Valdez  VDZ
Whittier WHT
Wrangell  WRG
Yakutat YA K	
Schedule B - Voyage Information	
Voyage # Port of Origin Final PortBegin Date
(MM/DD/YYYY) End Date
(MM/DD/YYYY) Total # of 
Passengers
Total from additional sheets (see instructions) Total	
Schedule C - Ports of Call Detail (Report first 7 
ports only)
Voyage # (Schedule B)Alaska Port of CallAlaska Port CodeNumber of Passengers
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7	
Continued on next page.  
210 
210

0405-210 Rev 10/12 - page 3	
Attach additional pages if more than eight voyages.	
Alaska Port Codes
Anchorage ANC
Dutch Harbor/Unalaska DH
Haines HNS
Homer  HOM
Juneau JNU
Ketchikan KTN
Kodiak KDK
Metlakatla  MET
Nome NOM
Petersburg PTB
Point Sophia/Icy 
Straits/Hoonah PTS
Seward  SEW
Sitka SIT
Skagway  SKG
St. Matthew  STM
Valdez  VDZ
Whittier WHT
Wrangell  WRG
Yakutat YA K	
Schedule C - Ports of Call Detail (Continued)
Voyage # (Schedule B)Alaska Port of CallAlaska Port CodeNumber of Passengers
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Port 1
Port 2
Port 3
Port 4
Port 5
Port 6
Port 7
Taxpayer Name Vessel NamePeriod Ending (year/month)  
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210

0405-210 Rev 10/12 - page 4	
Taxpayer NameVessel NamePeriod Ending (year/month)
Schedule D - Tax Reduction for Local Levies 
Attach additional pages if needed	
Voyage #
(Schedule B) Alaska Port Code
(JNU or KTN) Number of
Passengers Levy Rate Levy Amount
Collected
Subtotal
Total from additional pages
Total levies collected (also enter on schedule A, line 4)  
210 
210
Next: Alaska Corporation Net Income Tax Return Form Previous: Alaska Cigarette and Tobacco Products Monthly Tax Return Form
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