Form 04-200 - Tire Fee Quarterly Return
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Alaska Department of Revenue
DEPT USE ONLY
State of Alaska
Tax Division
ENV:
PO Box 110420
Tire Fees Quarterly Return
Juneau, AK 99811-0420
Telephone 907.465.2320
This form is available online at
Fax 907.465.2375
FSN:
Due Date: 30th day of the month following the end of the calendar quarter.
Check if amended return and attach explanation.
Federal EIN or SSN
Calendar Quarter Ending
AK Business License #
Name
E-mail Address
Mailing Address
Telephone Number
City
State
Zip Code
Fax Number
Contact Person
Title
Contact Telephone Number
Fee Calculation - All New Tires Including ALL NEW STUDDED TIRES
1. Total number of new tires sold (including all new studded tires)……………………… 1.
2.
Number of new tires sold to exempt persons and resellers (from Column D,
(
)
2.
Supporting Schedule of Exempt Sales)………………...………..…..……….……….
3. Number of taxable new tires sold (subtract line 2 from line 1)………………………… 3.
2.50
4. Tire fee rate per tire………………………………………………………………………… 4.
5. Total Tire Fees on New Tires (multiply line 3 by line 4)…………………………………………………………………………… 5.
Fee Calculation - NEW STUDDED TIRES and INSTALLATION OF STUDS
6. Total number of new studded tires sold………………………………………………… 6.
7. Total number of stud installations performed…………………………………………… 7.
8.
Number of studded tires sold & installations performed for exempt persons &
(
)
8.
resellers (from Column E, Supporting Schedule of Exempt Sales)……………..….
9.
Number of taxable studded tires sold & stud installations performed (add lines 6
9.
and 7, subtract line 8)…………...………...…...………..……………………..…..……
5.00
10. Studded tire fee rate per tire………………………………….……………………………10.
11. Total tire fees on studded tires and stud installations (multiply line 9 by line 10)……………………………………………… 11.
12. Total Tire Fees and Studded Tire Fees (add lines 5 and 11)……………………………………………………………………. 12.
(
)
13. Timely Payment Credit: 5% of line 12, not to exceed $900…………...…….…………………………………………………… 13.
14. Total Tire Fees due this quarter (subtract line 13 from line 12)……………………………………………………………………14.
AMENDED RETURNS ONLY
(
)
15.
Tire Fees previously paid for this calendar quarter………………… 15.
*
16.
………………………………………………………………………………… 16.
Amount Due
(subtract line 15 from line 14)
TOPS / Receipt Number ___________________________________
Check if you are remitting by:
Wire Transfer
To avoid wire transfer fees, use our free online EFT service, known as TOPS. Go to: https://
*
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 I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief it is true, correct and complete. If prepared by a person other than the taxpayer, the preparer's declaration is based on all information of which the
preparer has any knowledge.
Signature
Type or Print Name
Date
DEPARTMENT USE ONLY
VALIDATION
PMD
WebForm 04-200 (Revised 08/06)
Do not write in shaded areas.
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Parent category: Financial