Alcoholic Beverage Tax Report Form - Fairbanks
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1
2FAIRBANKS NORTH STAR BOROUGH
TREASURY AND BUDGET DIVISION
809 PIONEER ROAD
PO BOX 71320
FAIRBANKS, ALASKA 99707 1320
(907) 459-1443
ALCOHOLIC BEVERAGE TAX REPORT
FOR PERIOD ENDING
/
Month
Year
If CHANGE OF OWNER OR ADDRESS fill in below:
ACCOUNT NO.
Owner Name
Business Mailing Address
BUSINESS NAME
City/State
Zip Code
FINAL REPORT
If this is a
, return the Certificate of Registration &
state where the books will be located.
GROSS ALCOHOLIC BEVERAGE SALES…………………………..………………
1.
$
EXEMPT SALES PURSUANT TO BOROUGH CODE
…………
2.
3.59.040.B………….
$
(Please provide backup for exemptions)
SUBTRACT LINE 2 FROM LINE 1……………………………………………………
3.
$
MULTIPLY LINE 3 BY 5%
………………………………………………
4.
(LINE 3 X .05)
$
SALES TAX PAID ON THE SALES IN LINE 1 TO ANY MUNICIPALITY WITHIN
5.
THE BOROUGH
(attach documentation)
$
SUBTRACT LINE 5 FROM LINE 4……………………………………………………
6.
$
PENALTIES
7.
- See reverse side for information
Late Report/Late Remit Penalty
A.
(10% of the tax due or $50 for zero balance reports) $
Additional Late Report/Late Remit Penalty
………………………
B.
(25% of tax due)
$
Additional Penalty
…………………………………………...…
C.
($1,000 after 60 days)
$
INTEREST - 1.25%
per month…………………………………………
8.
(.0125 x Line 6)
$
LIABILITY FOR FILING PERIOD
……….………
9.
(Line 6 + Line 7A + Line 7B + Line 8)
$
MINUS CREDIT OR ADD OUTSTANDING LIABILITY……………………………
10.
$
TOTAL AMOUNT DUE WITH REPORT
…………………
11.
(Total of Line 9 and Line 10)
$
*** Any false statement on this form is punishable under AS 11.56.210 ***
I DECLARE THAT THIS REPORT, INCLUDING ANY ACCOMPANYING STATEMENTS, HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A
TRUE, CORRECT AND COMPLETE REPORT.
Date
Owner or Agent
06/05JV
White Copy (Borough)
Yellow Copy (Business)
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