Tobacco Excise Tax Return Form - City And Borough Of Juneau
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1FOR OFFICE USE ONLY
PROCESSING INSTRUCTIONS: Attach envelope to
return form upon receipt. Copy return form for cash
backup and submit original return form and merchant’s
City and Borough of Juneau, Alaska
Finance Department, Sales Tax Office
supporting documentation to the Sales Tax Office.
155 So. Seward St., Juneau, AK 99801
AMOUNT OF CHECK $
Ph (907)586-5265 Fax (907)586-0365
APPLY TO ACCOUNT CODE 221010101-4221
TOBACCO EXCISE TAX RETURN
COMPANY:__________________________________________
FOR THE QUARTER ENDING:__________________________
Column 1
Column 2
OTHER TOBACCO
CIGARETTES
PRODUCTS
Number of Packs
Wholesale Price
#
$
1. Cigarettes/Other Tobacco Products Imported or Acquired within CBJ
$
2. Less Adjustments:
(a) Volume Discounts (Does not Apply to Column 1) .........................
($
)
(b) Other Price Reductions (Does not Apply to Column 1) ..................
($
)
(c) Returned Merchandise .................................................................... (
) ($
)
3. Subtotal Adjustments (Sum Line 2a through 2c).................................. (
) ($
)
4. Adj Cigarettes/Other Tobacco Products (Subtract Line 3 from Line 1)
$
5. Less Exemptions:
(a) Military Sales .................................................................................. (
) ($
)
(b) Amount Prohibited from Taxation by Other Laws.......................... (
) ($
)
(c) Wholesaled Outside the Borough .................................................... (
) ($
)
6. Subtotal Exemptions (Sum Line 5a through 5c) ................................... (
) ($
)
7. Total Taxable (Subtract Line 6 from Line 4) ........................................
$
X $1.00 per Pack
X 45%
8. Tax Rate ...............................................................................................
9. Excise Tax Due (Multiply Line 7 by Line 8) ........................................ $
$
10. Total Tobacco Excise Tax Due (Add Line 9, Columns 1 and 2) ..................................................... $
11. Late Payment Penalty (5% per Month to Maximum of 25%) .......................................................... $
12. Late Payment Interest (1.25% per Month, 15% per Annum) .......................................................... $
13. Prior Period Adjustments ................................................................................................................ $
14. Total Amount Due with Return (Sum Line 10 through Line 13) .................................................... $
I certify under penalty of perjury that this return, including all accompanying schedules, has been examined by me and to the best of
my knowledge and belief is a true, correct and complete return of all cigarette and tobacco products imported into or acquired in the
City and Borough of Juneau, Alaska during the period specified above.
X
DATE
SIGNATURE OF FIRM MEMBER, OWNER OR AGENT
PRINTED NAME
PHONE NUMBER
Note: This return must be filed by each Taxpayer that imports or acquires tobacco products in the City and Borough of Juneau, even
if no products were imported during the months covered.
I:\webpage\tobacco
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