Form 04-408 - Affidavit Of Estimated Motor Fuel Excise Taxes - Alaska Department Of Revenue
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1Alaska Department of Revenue
Affidavit of Estimated Motor Fuel Excise Taxes
SEND TO:
Alaska Department of Revenue
Income and Excise Audit
DUE DATE: September 1 of each year.
PO Box 110420
Juneau, AK 99811-0420
NOTE: If at any time during the year these estimates are lower than actual gallons subject to tax, you must file
a corrected affidavit and comply with any additional tax security requirements. The corrected affidavit and
additional tax security is due within 30 days after you have knowledge of the underestimate.
A. Gallons
B. Motor Fuel
C. Motor Fuel
(Estimate the number of gallons
Excise Tax Rates
Excise Tax
that would be subject to tax
(Multiply column A
during an average month.)
by column B
AVIATION JET
$ .032
AVIATION GAS
$ .047
MARINE FUEL
$ .05
HIGHWAY FUEL
$ .08
GASOHOL
Exempt
Total Average Monthly Motor Fuel Tax Remittance (Add amounts in column C) ...............
Lienable Real Property. Indicate real property in Alaska on which motor fuel excise taxes may become a first lien. You must attach a
title search (current within 30 days of the application) along with either a current property tax assessment notice or independent
market appraisal. The value of the lienable real property must be equal to at least two times the total estimated tax.
% of Ownership
Real Property Address or Location
Fair Market Value
Legal Description
If the fair market value of the applicant’s interest in the property
Before me this day personally appeared the owner/operator to be
described above is not equal to at least twice the average monthly
known, and known by me to be the person(s) described in and who
motor fuel tax remittance, then you must:
executed the foregoing affidavit. WITNESS my hand and official
a. Secure a Qualified Dealer Bond (form 04-409) and file it with the
Department of Revenue in an amount equal to twice the
seal at _____________________________________________
average monthly motor fuel tax remittance but not less than
$5,000; or
in the State of _______________________________________
b. File a letter of credit or certificate of deposit from a bank with the
Department of Revenue in an amount equal to twice the
this __________ day of ______________________ , 19_____.
average monthly motor fuel tax remittance but not less than
$5,000; or
Signature: __________________________________________
c. Deposit cash with the Department of Revenue in an amount
equal to twice the average monthly motor fuel tax remittance but
Notary Public for: ____________________________________
not less than $5,000, submitted with this affidavit:
$_________________________
My Commission Expires: ______________________________
I declare under penalty of perjury that this affidavit, including any accompanying statements, has been examined by me and to the best
of my knowledge and belief is true, correct and complete.
Signature of Applicant
Title
Date
Form 04-408 (Revised 7/96)
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