Form 773 - Electronic Filing Waiver Application
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1773
Electronic Filing Waiver Application
Form
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
FEIN
Taxpayer Name
Contact Phone Number
SSN
Address
City
State
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.
Signature
Date
/
/
Printed Name
Phone Number
Title
* 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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