Production Tax Returns As 43.55 Monthly Signature Page To Accompany Cd-R

Production Tax Returns As 43.55 Monthly Signature Page To Accompany Cd-R - State Of Alaska

State of Alaska

Production Tax Returns AS 43.55

Monthly Signature Page to Accompany CD-R

Taxpayer Name:

___________________________________________

EIN:

___________________________________________

Address:

___________________________________________

Telephone Number:

___________________________________________

Contact Person:

___________________________________________

File Date of Return:

___________________________________________

Total Dollars Due:

___________________________________________

Unique Digital Code: Identify CD-R ___________________________________________

I, _____________________________________certify under penalty of perjury that I have

examined the return being submitted on the identified CD-R, including all schedules and statements,

and that it is true, correct, and complete to the best of my knowledge and belief.

Signature:

____________________________________

Title of Signatory:

____________________________________

Date:

____________________________________

This page along with the media being submitted for the production tax filing should be submitted

to:

Alaska Department of Revenue

(907) 269-6620

Tax Division

Attn: Production Tax Section

550 W. 7

Ave., Suite 500

Anchorage, AK 99501

Payment Reconciliation (optional)

____________________________________

Date of Payment

Amount of Payment:

___________________________________________

Form of Payment:

___________________________________________

Production Tax Returns As 43.55 Monthly Signature Page To Accompany Cd-R - State Of Alaska