Form 773 - Electronic Filing Waiver Application


Electronic Filing Waiver Application
Complete this form to request a waiver if you are unable to file electronically.
Waivers will be valid for five years after the first filing due date after the waiver is granted. An application for a waiver must be submitted
30 days before a return or report is due.
Taxpayer Information
Taxpayer Name
Contact Phone Number
Zip Code
Tax Type or Report
Check only the tax types below that have the same FEIN/SSN listed in Taxpayer Information.
Alcoholic Beverage Tax
Large Passenger Vessel Tax
Cigarette & Tobacco Tax
Mining License Tax
Commercial Passenger Vessel Tax
Motor Fuel Tax
Corporate Income Tax*
Oil & Gas Property Tax
Electric Cooperative Tax
Telephone Cooperative Tax
Fisheries Related Taxes** (see listing below)
Tire Fee
Charitable Gaming
Vehicle Rental Tax
Reason for Waiver
Check the reason a waiver is being requested and attach any additional supporting information.
No access to a computer
No internet availability
Other – state the specific reason
I declare under penalty of unsworn falsification that this application has been examined by me, and to the best of my knowl-
edge and belief is true, correct and complete.
Printed Name
Phone Number
* No waiver will be granted if taxpayer is required to electronically file its federal corporate income tax return.
** Includes Fisheries Business Tax, Fishery Resource Landing Tax, Seafood Marketing Assessment, Salmon Enhancement Tax, Re-
gional Seafood Development Tax, Dive Fishery Management Assessment, Common Property Fishery Assessment, and Alaska Salmon
Price and Production Reports.
Mail completed application to:
Alaska Department of Revenue, Tax Division, PO Box 110420, Juneau AK 99811-0420
• 907.269.6620
0405-773 11-30-16


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