Form 662sf - 2012 Alaska Mining License Tax Return - Short Form
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1
2DEPARTMENT USE ONLY
Alaska
ENV
662SF
2012 Mining License Tax Return-
FSN
Short Form
EIN
Mining License #
Complete only if fiscal year
filer
SSN
Year ending (Year/Month)
Taxpayer Name
Telephone Number
Business Name
E-mail Address
Check if:
Mailing Address
Taxpayer type:
CHECK ALL THAT APPLY
Renew my license for next year
Owner
City
State
Zip Code
Lessor
Inactive
Contact Person
Title
Operator
Amended (attach explanation)
THIS FORM CAN ONLY BE USED BY CASH BASIS TAXPAYERS WITH ONE MINING OPERATION AND NO NON-MINING
EXPENSES (see instructions)
INCOME
1 Gross income from mining operation
1
2 Royalties received (Schedule C, line 2)
2
3 Total income (add lines 1 and 2)
3
EXPENSES
4 Royalties paid (Schedule B, line 3)
4
5 Fuel and oil
5
6 Maintenance and repairs
6
7 Salaries and wages
7
8 Transportation costs
8
9 Depreciation expense
9
10 Other expenses (attach schedule)
10
11 Total expenses (add lines 4 through 10)
11
12 Net income before depletion (line 3 minus line 11)
12
13 Depletion expense (Schedule A, line 16)
13
14 Taxable Income before exemption for new mining operation (subtract line 13 from line 12)
14
15 Exemption for new mining operation (see instructions)
15
16 Net taxable income (subtract line 15 from line 14)
16
17 Tax (see instructions)
17
18 Exploration incentive credit (attach Form 0405-665)
18
19 Mining business education credit (line 6 of Schedule EC, can be found on Form 0405-662)
19
20 Amount paid with extension
20
21 Amended returns only. Amount paid with original return
21
22 Net tax due or (overpayment). (Subtract lines 18, 19, 20 and 21 from line 17)
22
Note: If your liability is $150,000 or more, you must pay using the Online Tax Information System (OTIS) at or wire transfer.
Check if you are paying by:
OTIS (confirmation # ______________________________)
Wire transfer (date __________________)
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.
Signature
Printed Name and Title
Date
DEPARTMENT USE ONLY
VALIDATION
PMD:
662SF
Mail to: Alaska Department Of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-662SF Rev 10/12 - page 1
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