Form 04-503 - Alcoholic Beverage Excise Tax Return
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This form is available online at
State of Alaska
State of Alaska
Department of Revenue, Tax Division
Alcoholic Beverage Excise Tax Return
PO Box 110420
Juneau, AK 99811-0420
AS 43.60
DEPT USE ONLY
ENV #
Telephone 907.269.6620; Fax 907.269.6644
FSN:
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
bonded warehouse in Alaska.
Required Attachments: Attach the original copies of all supporting schedules (Forms 04-501 and 04-502) and inventory reports (Form 04-503).
Federal EIN or SSN
For the month of
Year
Individual or Corporation Name
License Number
Check if:
Amended (Attach Explanation)
Business Name
Telephone Number
Fax Number
Mailing Address
E-mail Address
City
State
Zip Code + 4
Contact Person
Title
TAX CALCULATION: Complete the information requested below. Do not include gallons received by a bonded warehouse.
1. GALLONS OF LIQUOR
District 1
District 2
District 3
District 4
Total
0.000
a. Sold or consigned in Alaska. . . . . . . . . . . . . . . . . . .
0.000
b. Sold to military. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (
) (
)
(
)
(
) (
)
0.000
c. Sold or consigned to licensed warehouse. . . . . .
(
) (
)
(
)
(
) (
)
0.000
0.000
0.000
0.000
d. Taxable gallons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0.000
e. Tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $12.80
f. Total tax (multiply taxable gallons by tax rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$0.00
2. GALLONS OF WINE
0.000
a. Sold or consigned in Alaska. . . . . . . . . . . . . . . . . . . . .
0.000
b. Sold to military. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (
) (
)
(
)
(
) (
)
0.000
c. Sold or consigned to licensed warehouse. . . . . .
(
) (
)
(
)
(
) (
)
0.000
0.000
0.000
0.000
0.000
d.
Taxable gallons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$2.50
$0.00
f.
Total tax (multiply taxable gallons by tax rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. GALLONS OF BEER, MALT BEVERAGES & CIDER
0.000
a. Sold or consigned in Alaska. . . . . . . . . . . . . . . . . . . . .
0.000
b. Sold to military. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (
) (
)
(
)
(
) (
)
0.000
c. Sold or consigned to licensed warehouse. . . . . .
(
) (
)
(
)
(
) (
)
0.000
0.000
0.000
0.000
0.000
d.
Taxable gallons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$1.07
$0.00
f.
Total tax (multiply taxable gallons by tax rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. GALLONS OF BEER & MALT BEVERAGES QUALIFYING FOR REDUCED RATE OF TAX (see instructions)
0.000
a. Sold or consigned in Alaska. . . . . . . . . . . . . . . . . . . . .
0.000
b. Sold to military. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (
) (
)
(
)
(
) (
)
0.000
c. Sold or consigned to licensed warehouse. . . . . .
(
) (
)
(
)
(
) (
)
0.000
0.000
0.000
0.000
0.000
d.
Taxable gallons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Tax rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$0.35
$0.00
f.
Total tax (multiply taxable gallons by tax rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TOTALS
DEPT USE ONLY
*
$0.00
5.
Total Alcoholic Beverages Tax Due
(add lines 1f, 2f, 3f, and 4f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Check if you are remitting by:
TOPS / Receipt Number ___________________________________________
Wire Transfer
To avoid wire transfer fees, use our free online EFT service, known as TOPS. Go to: https:// or call us for information.
* YOU MAY MAKE A WIRE TRANSFER OR ELECTRONIC FUNDS TRANSFER (EFT) USING TOPS FOR ALL TAX PAYMENTS. HOWEVER, IF THE
AMOUNT DUE IS $100,000 OR MORE, YOU MUST PAY BY WIRE TRANSFER OR EFT IN ACCORDANCE WITH 15 AAC 05.310.
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. If prepared by a person other than the taxpayer, preparer's declaration is based on all information of which preparer has any knowledge (AS
43.05.290).
Signature
Printed Name
Date
DEPT USE ONLY
Validation
PMD:
Form 04-500 Webform (Rev 08/04)
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