Form 403 - Alcoholic Beverage Excise Tax State Bonded Warehouse License Application
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Alaska
403
Alcoholic Beverage Excise Tax
State Bonded Warehouse License Application
Is this a renewal?
Email Address
License Year
EIN
Yes
No
SSN
Taxpayer Name
Business Name
Business Telephone
Mailing Address
City
State
ZIP Code
Warehouse Owner
Contact Telephone
Warehouse Physical Address
City
State
ZIP Code
Name of personnel who may authorize immediate inspection of the licensed warehouse. Use additional pages as necessary.
Estimated Maximum Monthly Inventory Tax Calculation
Estimated maximum monthly
Alcoholic beverages excise
inventory for license year
Excise tax
tax rates
(gallons)
Liquor
X
$12.80
=
Wine & other
X
$2.50
=
Beer, cider & malt beverages
X
$1.07
=
Beer (microbreweries)
X
$0.35
=
Total estimated maximum monthly tax
=
Your estimated maximum monthly tax liability must be secured by a surety bond or at its discretion, DOR may issue a permit
in lieu of a bond.
Surety bond in the amount of $25,000 or an amount equal to the total estimated maximum monthly inventory tax indicated above;
attach the License Warehouse Bond Form 405W.
Permit in lieu of bond(cash, letter of credit or certificate of deposit from an Alaska bank in an amount equal to the total estimated
maximum monthly inventory tax indicated above). You must be doing business wholly in the state of Alaska to qualify. For new
applicants, attach a written request for a permit in lieu of bond.
Note: If the potential amount of alcoholic beverage excise tax on the inventory in the warehouse at any time exceeds the
secured amount by more than 10%, the owner/operator must increase the security to equal the additional amount within
30 days after the difference has been discovered. The discovery would normally occur at the end of the month when an
inventory is taken for the purpose of preparing the monthly tax return. Failure to comply with this security requirement will
result in revocation of the Bonded Warehouse License per 15 AAC 60.090(b)(2).
I declare under penalty of unsworn falsification that this application and any attachments have been examined by me and to the best of my
knowledge and belief are true correct and complete, I agree to pay all alcoholic beverage excise taxes imposed by AS 43.60. That are not
collected, for any reason, from the owners, on alcohol sold or consigned from the licensed warehouse. I agree to file a monthly tax return.
Signature of Applicant (must be an owner or corporate officer)
Printed Name
Date
Pay online at
Online payment receipt # ________________
or make check payable to State of Alaska
403
Mail to: Alaska Department of Revenue, 550 W 7th Ave STE 500, Anchorage AK 99501-3555
0405-403 Rev 09/12
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