Form 500 - Alcoholic Beverage Excise Tax Return Page 2
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7Alaska
500
Alcoholic Beverage Excise Tax Return
Business Name
Month and Year
Page ______of
______
Licensed Location
DOR License Number
Schedule B:
Gallons Sold in Alaska
This is a supporting schedule of taxable gallons sold in Alaska to retail establishments and individuals. Each district total
and alcohol type total should be reported on Line (a) of sections 1 - 4 of Schedule A and line 4 of Schedule G, the Inventory
Report. Use additional sheets as necessary.
Number of Gallons
Judicial
Qualified
Name AND Alaska address of taxable sales to
District
Beer, Malt
Reduced Tax
retailers or individuals (A single line should be used
(destina-
Liquor
Wine
Beverages &
Rate Beer &
to report the total of all individual consumer sales)
tion of the
Cider
Malt Beverages
sale)
0.000
0.000
0.000
0.000
Totals:
500
Retain a copy for your records
0405-500 Rev 12/10 • page 2
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