Form 522 - Cigarette And Tobacco Products Monthly Tax Return - State Of Alaska Page 4
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8522
Schedule F
Alaska Cigarette Transactions
Do not report other tobacco products here. Use Schedule G to report other tobacco products.
License Number
Name of Licensee
Period Ending (yyyymm)
Federal ID
You must complete this schedule if you manufactured, imported, acquired or sold cigarettes in the state during the month covered by this
return. Use a separate schedule for each type of transaction that applies to your business identified in boxes A through E below. Use
additional pages as necessary. All invoices supporting transactions identified in boxes A through E must be attached to this schedule to
constitute a complete filing.
Check one:
A. Cigarettes manufactured, imported, acquired or sold
B. Cigarettes sold to military
C. Cigarettes sold to Metlakatla Indian Reservation or Klawock Smoke Shop
D. Unstamped cigarettes returned to manufacturer. You must attach an affidavit from the manufacturer supporting the
number of cigarettes returned. Do not report the return of stamped cigarettes on this schedule. Use Schedule J.
E. Unstamped cigarettes destroyed. You must attach U.S. Treasury Department Form ATF-F 5200.7 or certification
from the manufacturer attesting to the destruction. Do not report the destruction of stamped cigarettes on this
schedule. Use Schedule J.
Invoice date
Name of supplier or purchaser
Invoice number
Number of cigarettes
TOTALS CARRIED FORWARD FROM PREVIOUS PAGE(S)
Total
Page number
_______
_______
of
522
0405-522 Rev 09/12 - page 4
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