Form 522 - Cigarette And Tobacco Products Monthly Tax Return - State Of Alaska

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DEPARTMENT USE ONLY
Alaska
ENV
522
Cigarette and Tobacco Products
FSN
Monthly Tax Return
DUE DATE:
The last day of the month following the month in which cigarettes and tobacco products
were manufactured, imported, acquired or sold or in which tax stamps were purchased.
License Number
Period Ending (yyyymm)
AK Business License Number
EIN
SSN
Name
Telephone Number
Fax Number
Mailing Address
Contact Person
Contact Telephone
City
State
ZIP + 4
Contact Email
Check here if you have been approved to purchase cigarette tax
Check here if no activity for the month. Sign and date below
stamps under a deferred payment plan
Check if amended return and attach explanation
Schedule A - Payment Due for Cigarette Tax Stamps
1
Cigarette tax due on the purchase of cigarette tax stamps for the month. From Schedule E, line 7, column (b)
1
(
)
2
Less stamp discount from Schedule H or I
2
(
)
3
Less cigarette tax stamp credits from Schedule J, line 19
3
(
)
4
Cigarette tax paid with stamp order. From Schedule E, line 7, column (c)
4
5
Cigarette tax due (overpaid) with this return. Subtract lines 2, 3 and 4 from line 1 (see instructions)
5
Schedule B - Tobacco Products Excise Tax Liability
(Total carried forward from Schedule G)
6
Wholesale price of tobacco products manufactured, imported, acquired or sold during the month
6
(
)
7
Less military sales (see instructions)
7
(
)
8
Less Indian sales - Metlakatla Indian Reservation or Klawock Smoke Shop (see instructions)
8
(
)
9
Less other credits (see instructions)
9
Total wholesale price of tobacco products manufactured, imported, acquired or sold. Subtract
10
10
lines 7 through 9 from line 6
11 Tax @75% of wholesale price. Multiply line 10 by .75
11
(
)
12 Less .4% commission for expense of tobacco products tax collections. Multiply line 11 by .004
12
13 Total tobacco products excise tax due. Subtract line 12 from line 11
13
14 Total cigarette and tobacco products tax due (overpaid). Add line 5 and 13
14
(
)
15 Amended returns only. Cigarette and tobacco products tax previously paid for this month
15
16 Total amount due (overpaid). Subtract line 15 from line 14. If line 16 shows tax due,
16
payment must be remitted by the due date of the return to avoid a late payment penalty.
Electronic Payment Information
Note: If your liability is $100,000 or more, you must pay using the Online Tax Information System (OTIS) at or by wire transfer.
Check if you are paying by:
OTIS confirmation #
Wire transfer date
I declare under penalty of perjury that this return, including all accompanying scheduling and invoices, has been examined by me and to the best of my
knowledge and belief is a true, correct and complete return.
Signature of Taxpayer
Date
Printed Name
Printed Title
Department Use Only PMD
Validation
522
0405-522 Rev 09/12 - page 1

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