Fillable Form 0405-200 - Tire Fees Quarterly Return (Page 3 of 3) in pdf

Form 0405-200 - Tire Fees Quarterly Return Page 3

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Alaska

200

Tire Fees Quarterly Return

Schedule B - Supporting Schedule of Exempt Sales

AK Business License #

EIN

SSN

Name

Calendar Quarter Ending

This is a supporting schedule for Alaska Tire Fees Quarterly Return Form 200. Tire sellers must complete this schedule if they sold new tires, studded tires,

or installed studs for exempt purchasers as provided by AS 43.98.025(g). The number of exempt tires sold must agree with the number of exempt tires &

services reported on lines 2 and 8 of Form 200. Attach this schedule to your Tire Fees Quarterly Return. Use additional pages as necessary.

Note: The exemption only applies to those entities described in AS 43.98.025(g) and which have provided you a completed certificate of use.

Page _____ of _____

Number of Studded Tires

Number of New

Name of Exempt Purchaser

Invoice Date

Invoice Number

Sold & Stud

Tires Sold

Installations Performed