Form 0405-520 - State Of Alaska Cigarette And Tobacco Products Tax License Application
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1State of Alaska
520
Cigarette and Tobacco Products Tax
License Application
Note: We will issue your license in the individual or corporation name given below. All state tax returns must be filed under the same
name and EIN or SSN. Except for vending machine operators, all persons operating more than one place of business must obtain a
separate license for each place of business.
Enter a Federal EIN if the business is a corporation or partnership so that the Department of Revenue may administer the tax laws of
Alaska AS 43.05.080. The information is used by the department for identification purposes.
Federal ID
SSN
EIN
License number
Business type
Corporation
License year
Is this a renewal?
Yes
No
Partnership
Individual
Taxpayer name
Physical location where this license is applicable
Business name
Telephone number
Fax number
Mailing address
Contact email
Contact phone number
City
State
ZIP+4
Contact person
Select License Type Below
See instructions for definitions of license types. The license fee must accompany the application. Please be advised that by applying for
a license authorizing the sale of cigarettes, you are agreeing to purchase and affix cigarette tax stamps, or designate a third party to do
so on your behalf, as the means of paying the state excise tax.
Cigarettes and Tobacco Products
License Fee
Buyer
$25
Direct-buying retailer
$50
Distributor
$50
Manufacturer
$50
Vending machine operator
$50
Wholesaler - distributor
$50
Tobacco Products Only (Persons who exclusively import and/or acquire tobacco products other than cigarettes)
Distributor
$50
Explain, in general, the nature of your business. Indicate the sources of your purchase and to whom you distribute.
I certify that an accurate record will be kept of cigarettes and other tobacco products manufactured, imported, acquired or sold from any
source whatever and that the required returns will be filed on or before the last day of each calendar month and that the tax stamps will
be affixed before sale or distribution.
Signature
Title
Date
Pay online at
Mail to: Alaska Department of Revenue - Tax Division
Online payment receipt # ________________
550 W 7th Ave Ste 500 • Anchorage AK 99501-3566
or make check payable to State of Alaska
Telephone 907-269-6620
FAX 907-269-6644
dor.tax.cigarette@alaska.gov
520
Retain a copy for your records
Form 0405-520.webform (rev 05/09) • page 1
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