Form 210 - Commercial Passenger Vessel Excise Tax Monthly Return

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210
Alaska
Department Use Only
Envelope
Commercial Passenger Vessel Excise Tax
FSN
Monthly Return
Due Date: Last day of the month following the month in which voyages were completed.
You can file this return and pay on-line using the Online Tax Information System (OTIS) at
Vessel Call Sign
Period Ending (year/month)
EIN
Check if amended return and
attach explanation
SSN
Taxpayer Name
Vessel Name
Mailing Address
Contact Person
City
State
Zip Code
Contact Phone
Fax Number
Country (if other than U.S.)
Contact Email Address
Schedule A – Commercial Passenger Vessel Excise Tax Calculation
1. Total number of passengers (total from Schedule B)
1
$34.50
2. Tax rate
2
3. Tax (multiply line 1 by the tax rate on line 2)
3
4. Tax Reduction for Local Levies (total from Schedule D)
4
(
)
5. Total tax (line 3 less line 4)
5
6
(
)
6. AMENDED RETURNS ONLY - amount previously paid with originally filed return
7. Total amount due (overpaid) (line 5 less line 6)
7
Electronic Payment Information
Note: if your liability exceeds $100,000 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 the information provided in this return, including all accompanying schedules and statements, has
been reviewed by me and to the best of my knowledge and belief is true, correct and complete.
Signature of Taxpayer
Date
Print Name
Print Title
VALIDATION
DEPT USE ONLY
PMD
Pay online at
or make check payable to State of Alaska
210
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-210 Rev 10/12 - page 1

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