Vessel Excise Tax Monthly Return Form

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Alaska Commercial Passenger
210
Department use only envelope #
Vessel Excise Tax Monthly Return
FSN
SEQ #
Due Date: Last day of the month following the month in which voyages were completed.
Federal ID
SSN
EIN
Vessel call sign
Period ending (year/month)
Taxpayer name
Vessel name
Check if amended
Mailing address
Fax number
Telephone number
City
State
ZIP + 4 (Postal code)
Country (other than U.S.)
Contact email
Contact telephone number
Schedule A – Commercial Passenger Vessel Excise Tax Calculation
1. Total number of passengers (line 7 of Schedule B)
1
$46
2. Tax rate
2
3. Total tax (line 1 times line 2)
3
4. Amended returns only - amount previously paid with originally filed return
4
5. Total amount due (overpaid) (line 3 less line 4)
5
Electronic Payment Information
Note: If your liability exceeds $100,000, you must use the Tax Online Payment System (TOPS) at or wire transfer.
Check if you are remitting by:
TOPS confirmation #
Wire transfer date
I declare under penalty of perjury that the information provided in this return, including all accompanying schedules and statements, has
been reviewed by me and to the best of my knowledge and belief is true, correct and complete.
Date
Signature of taxpayer
Print name
Print title
Pay online at
Department use only PMD
or make check payable to State of Alaska
Validation
Mail to: Alaska Department of Revenue - Tax Division
PO Box 110420 • Juneau AK 99811-0420
Telephone 907.465.2320
FAX 907.465.2375
Retain a copy for your records
210
Form 0405-210.1 New 04/07 • page 1

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