Cigarette Tax Stamp Application And Designation Of Delivery Method - Alaska Department Of Revenue Page 2
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2INSTRUCTIONS
Alaska Cigarette Tax Stamp Application and Designation of Delivery Method
Where to Send Form 04-621
General Instructions
Form 04-621 may be mailed or delivered to the Department
Effective January 1, 2004, the cigarette excise tax
of Revenue, Tax Division, 550 W. 7th Avenue, Suite 500,
authorized by AS 43.50 must be paid through the use of
Anchorage, AK 99501. To immediately establish your
cigarette tax stamps. Cigarette tax stamps are required to
account to purchase cigarette tax stamps, you may fax the
be affixed to packages of cigarettes before sale or
form to 907.269.6644. However, final set up of your
distribution in the state. Form 04-621 is used to apply to the
account will not be done until the original form is received
Tax Division to purchase cigarette tax stamps and
with the proper signature.
designate the method of delivering the tax stamps to you.
Questions
Please Note: Pursuant to Alaska Statute 43.50.540(f), title
to the stamps passes immediately to the licensee at the
time the stamps are obtained in person or, if the stamps are
If you have questions about this form, please contact the
shipped or transported, at the time the stamps are placed in
Tax Division at 907.269.6620.
the United States mail or received by the common or private
carrier.
The licensee bears all costs associated with
shipping or transporting the stamps and all risks of possible
loss or damage while in transit. Once you have designated
a delivery method, you must complete a new form to
change the method.
Specific Instructions
If you will be picking up the stamps in person from the Tax
Division's Anchorage office, check the box indicating that
you will pick up the stamps. Provide the names of the
individuals authorized to pick up stamps on behalf of the
licensee identified on the form. Include the name of the
licensee, if applicable. The Tax Division will not release
stamps to an individual that is not listed on the form.
Identification will be required from an individual that is listed
on the form before the stamps will be released. No
exceptions will be made.
If you want the Tax Division to ship the stamps to you,
check the proper box indicating the desired shipping
method. Provide the shipping address if you wish to have
the stamps shipped to an address other than the address
indicated at the top of the form. You must provide your
account number with the shipping company or make prior
arrangements to ensure the shipping company is paid for
their services. Under no circumstances will the Tax
Division pay to have tax stamps shipped to you.
Signature
Form 04-621 must be signed and dated by the licensee or
the licensee's designee.
Unsigned forms will not be
accepted.
Form 04-621 Instructions (New 01/04)
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