Form 407 - Division Of Alcoholic Beverages And Tobacco - Division Of Alcoholic Beverages And Tobacco
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407
Alaska Qualified Motor Fuel Dealer
License Application
Federal ID
SSN
EIN
Alaska business license number
Entity type
Corporation
Partnership
Individual
LLC *
* Attach a list of owners, their addresses, and phone numbers
Taxpayer name
Contact person
Business name
Contact telephone
Contact fax
Mailing address
City
Contact email
State
ZIP + 4
1001-0147
License Type
Check the appropriate box.
Refines, blends, imports, manufactures and/or produces motor fuel
Sells at least 50 percent of fuel to another party for resale and/or for residential heating purpose
Sells at least 50 percent of fuel to another party for use in jet propulsion aircraft
Affidavit of Estimated Tax
If at any time during the year these estimates are lower than actual gallons subject to tax, you must file an amended affidavit and com-
ply with any additional security requirements if applicable. The amended affidavit and additional tax security is due 30 days after you
have knowledge of the underestimate.
Estimated monthly sales (gallons)
Tax rate
Tax liability
Jet fuel
X
$0.032
=
Aviation gas
X
$0.047
=
Marine diesel & gasoline
X
$0.05
=
Highway diesel & gasoline
X
$0.08
=
Highway gasoline special rate
X
$0.02
=
Heating fuel diesel (exempt)
X
$0.00
=
Total estimated maximum monthly tax liability (add amounts in this column)
=
Your estimated maximum monthly tax liability must be secured either by a bond, cash, letter of credit, or certificate of deposit from an
Alaska bank. Check one.
Bond in an amount equal to twice the average monthly
Cash, letter of credit or certificate of deposit from an Alaska
motor fuel tax remittance but not less than $5,000.
bank in an amount equal to twice the average monthly
motor fuel tax remittance but not less than $5,000.
Location of storage facility or base port of mobile operations
Facility or vessel capacity
Legal description or vessel name(s)
Qualified dealer reports are available at
I certify that an accurate record will be kept of all purchases, sales and uses of fuel, required monthly returns will be filed and taxes
will be paid on or before the last day of the following calendar month. Under penalty of perjury, I declare that this application and
any attachments have been examined by me and to the best of my knowledge and belief are true, correct and complete.
Date
Signature
Printed name
Mail to: Alaska Department of Revenue - Tax Division
Department use
Approved
Disapproved
550 W 7th Ave Ste 500 • Anchorage AK 9950-3566
License number
Examined by
Telephone 907.269.6620 • FAX 907.269.6644
Email dor.tax.motorfuel@alaska.gov
407
Retain a copy for your records
Form 0405-407 web rev 08/07 • page
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