Form 04-675 - Mining License Tax On Royalties
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1State of Alaska
DUE DATE:
SEND TO:
For Calendar Year taxpayers the return is due before
Mining License Tax on Royalties
Alaska Department of Revenue
May 1 of the following year. For Fiscal Year
PO Box 110420
taxpayers the return is due before the first day of
Authority: AS 43.65
Juneau, AK 99811-0420
the fifth month following the year end.
NOTE: Use this short form when reporting gross income from royalties provided no other income was received from mining operations.
Name of Individual, Partnership or Corporation
Federal EIN or Soc. Sec. No.*
Calendar Year
Fiscal Year:
Beginning_________________________, 19_____
Ending___________________________, 19_____
Mining License Number(s)
Telephone:
Name of Business
FAX:
Certificate of Exemption Number(s)
* If your business has not been issued a fed-
Mailing Address
eral employer identification number (EIN),
you are required to provide your social secu-
rity number so that the Department of Rev-
Resource Extracted
City, State, Zip Code
enue may administer the tax laws of Alaska.
AS 43.05.080. The information is used by the
department for identification purposes.
DEPT USE ONLY
1. Total gross income from royalties. (Schedule A, line 18) ......................................................................
1
2. Depletion. Schedule BR, line 9 ................................................................................................................
2
3. Net income from royalties. Subtract line 2 from line 1 ............................................................................
3
4. Computation of tax based on net income reported on line 3.
A. Exemption claimed (Enter 0 under tax below)
Date of Initial Production _________________________________________________________________
B. Less than or equal to $40,000. The tax due is zero.
C. Over $40,000 and less than or equal to $50,000. The tax rate if 3% (.03).
D. Over $50,000 and less than or equal to $100,000. The tax rate is $1,500 plus 5% (.05) of excess over $50,000.
E. Over $100,000. The tax rate is $4,000 plus 7% (.07) of excess over $100,000.
Tax
.........................................................................................................................................................
4
5. Alaska education credit (attach Form 04-706) ........................................................................................
5
6. Exploration Incentive Credit (Contact Department of Revenue) ..............................................................
6
7. Tax due. Subtract lines 5 and 6 from line 4 (not less than zero) ...........................................................
7
8. Paid with extension ..................................................................................................................................
8
9. Total tax due. If line 7 is larger than line 8, enter amount owed ............................................................
9
10. Overpayment. If line 8 is larger than line 7, enter amount of overpayment to be refunded ..................
10
11. a. Penalty for late filing (5% per 30 day period or fraction of a period, not to exceed 25%) ...............
11a
b. Penalty for late payment (5% per 30 day period or fraction of a period, not to exceed 25%) ........
11b
12. Interest (11% compounded quarterly) .....................................................................................................
12
13. Balance due. Add line 9 plus lines 11 - 12 .............................................................................................
13
I declare under penalty of unsworn falsification that this return, including all accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is a true, correct and complete return.
Title
Signature of Taxpayer
Date
Form 04-675 (Revised 3/97)
Page 1
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