Form 04-622 Transfer Of Cigarette Tax Stamps
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1
2INSTRUCTIONS
Alaska Transfer of Cigarette Tax Stamps
Unauthorized transfer of unaffixed stamps.
General Instructions
A licensee may not sell, exchange, or otherwise
transfer stamps not affixed to a package of
Effective January 1, 2004, the cigarette excise
cigarettes to another person without the prior
tax authorized by AS 43.50 must be paid
written approval of the Department. The
through the use of cigarette tax stamps.
Department may assess a civil fine of not less
Cigarette tax stamps are required to be affixed
than $1,000 nor more than $10,000 for a
to packages of cigarettes before sale or
violation of this provision.
distribution in the state. Cigarette licensees
may not sell, exchange, or transfer unaffixed
Signatures
cigarette tax stamps without prior written
approval by the Department of Revenue. Form
04-622 is used to request approval for the
Form 04-622 must be signed and dated by the
transfer of cigarette tax stamps.
licensee transferring the cigarette tax stamps
and the licensee receiving the cigarette tax
stamps.
Specific Instructions
Where to Send Form 04-622
Part I
Enter information regarding the licensee
transferring the cigarette tax stamps.
Form 04-622 must be mailed or delivered to the
Department of Revenue, Tax Division, 550 W.
Part II
7th Avenue, Suite 500, Anchorage, AK 99501
Enter information regarding the licensee
or faxed to 907.269.6644. After the form has
receiving the cigarette tax stamps.
been approved or denied, a copy will be
returned to both the licensee transferring the
Part III
cigarette tax stamps and the licensee receiving
Enter information regarding the cigarette tax
the cigarette tax stamps.
stamps being transferred.
If this transfer is approved, the number of
PM cigarettes are cigarettes manufactured by
stamps transferred as reported in Part III,
those companies that signed the tobacco master
Column C must be reported on Schedule D-1 or
settlement agreement. NPM cigarettes are
D-2, Cigarette Tax Stamp Inventory Report, of
cigarettes manufactured by those companies
Form 04-522, Cigarette and Tobacco Products
that did not sign the tobacco master settlement
Monthly Tax Return, for the period in which the
agreement. A list of PM and NPM cigarettes
stamps were transferred.
approved for sale in Alaska can be found on our
website at
Questions
CompliantTPMBrandListings.pdf.
If you have questions about this form, please
contact the Tax Division at 907.269.6620.
Penalties
Form 04-622 Instructions (Rev 12/04)
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