Form 0405-056 - Alaska Electric Cooperative Gross Revenue Tax Return
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DEPARTMENT USE ONLY
Alaska
ENV
056
FSN
Electric Cooperative Gross Revenue
Tax Return
(AS 10.25.555)
Due Date: Before the first day of March following the close of the taxable year.
Alaska Business License Number
Calendar Year
Federal EIN
Business Name
Contact Person
Contact Telephone
Fax Number
Mailing Address
State
Zip Code
Contact Email
City
(A)
Computation of Tax
(B)
TAX
Number of Kilowatt Hours Sold
Tax Rate
Column (A) X (B)
1. Cooperative furnishing service for less than five years
0.00025
as of December 31.......................................................
2. Cooperative furnishing service for five years or
0.0005
longer as of December 31............................................
3. Total Tax Due. Enter applicable amount here....................................................................................................
Allocation Schedule (This section must be completed so refunds to local governments can be made in accordance with
AS 10.25.570)
City or Borough in which
Applicable Tax
Kilowatt Hours Sold
Amount of Tax
Electricity Provided
Rate
TOTAL
If more space is needed for additional taxing authorities, attach a separate schedule and enter
the total amount here......................................................................................................................
TOTAL (must equal the amount of line 3 above).............................................................................
I declare under penalty of perjury that this return, including all accompanying schedules and statements, has been examined
by me and to the best of my knowledge and belief is a true, correct and complete return.
Taxpayer Signature
Title
Date
Department Use Only
Validation
PMD
056
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-056 Rev 01/13
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