Instructions for Alaska Application to Purchase
Cigarette Tax Stamps on a Deferred Payment Basis
If you fail to make payment at the time due, we will assess all
General Instructions
penalties and interest and suspend your privilege to purchase
Effective January 1, 2004, the cigarette excise tax authorized by
AS 43.50 must be paid through the use of cigarette tax stamps.
cigarette tax stamps on a deferred-payment basis.
Cigarette tax stamps are required to be affixed to packages
of cigarettes before sale or distribution in the state. Cigarette
Suspension of Deferred-Payment Basis Privilege
licensees must pay for cigarette tax stamps at the time they
The department may suspend, without prior notice, your privilege
are ordered unless they have prior written approval from the
to purchase stamps on a deferred-payment basis or reduce the
department to purchase cigarette tax stamps on a deferred
monthly dollar amount of purchases made on a deferred-payment
payment basis. Form 623 is used to request approval to purchase
basis for the following reasons:
cigarette tax stamps on a deferred payment basis.
1. You fail to pay for stamps when payment is due;
Specific Instructions
2. Your bond is cancelled or becomes void,
Determine the maximum dollar amount of cigarette tax stamps
impaired, or unenforceable;
you will want to purchase on a deferred payment basis each
3. The department determines that the collection
of an amount unpaid or due is jeopardized; or
month. A surety bond in the amount of 100 percent of the
maximum dollar amount requested must be obtained before the
4. You violate a state statute or regulation related
department will review your request.
to the collection of taxes under this chapter.
Beginning January 1, 2005, a licensee that holds a license issued
Questions
under AS 43.50.010 for a physical location in Alaska and has
If you have questions about this form, please contact the Tax
been in full compliance with the provisions of AS 43.50 during the
Division at 907-269-6620 or dor.tax.cigarette@alaska.gov.
preceding 60 months, may reduce the surety bond requirement
to 100 percent of the maximum dollar amount of cigarette tax
stamps purchased on a deferred payment basis each month.
Complete Form 041D and attach it to this request.
Earlier
versions of Form 041D will not be accepted. The surety bond
executed between you and the surety company on a form or in a
format different from Form 041D may be accepted provided that
all information required on Form 041D is provided.
Signatures
Form 623 must be signed and dated by the licensee and the
Cigarette Security Bond, Form 041D must be signed by an
authorized representative of the surety company.
Unsigned
forms will not be accepted.
Where to Send Form 623
TAX DIVISION
ALASKA DEPARTMENT OF REVENUE
550 W 7TH AVE STE 500
ANCHORAGE AK 99501-3566
After the application has been approved or denied, a copy will be
returned to you. You may begin to make purchases of cigarette
tax stamps on a deferred payment basis only after the form is
approved. Generally, the approval will expire at the same time
as the surety bond. You may also fax the form to 907-269-6644,
however final approval will not be given until the original signed
surety bond is received by the department.
Payment Due Date
If you are approved to purchase cigarette tax stamps on a
deferred payment basis, payment is due by the end of the month
following the month in which you purchased the tax stamps. You
should remit payment with your monthly tax return, Form 522.
0405-623i Rev 08/12