Form 500 - Alcoholic Beverage Excise Tax Return Page 5

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Alaska
500
Alcoholic Beverage Excise Tax Return
Business Name
Month and Year
Page ______of
______
Licensed Location
DOR License Number
Schedule E:
Gallons Sold Out of State
This is a supporting schedule of tax exempt gallons shipped for sale or consignment out of state. The total must be reported
on line 7 of Schedule G, the Inventory Report. Use additional sheets as necessary.
Number of Gallons
Qualified
Beer, Malt
Name AND address of tax exempt sales or consignments
Reduced Tax
Liquor
Wine
Beverages &
out of state.
Rate Beer &
Cider
Malt Beverages
0.000
0.000
0.000
0.000
Totals:
500
Retain a copy for your records
0405-500 Rev 12/10 • page 5

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