Form 539 - Election To Defer Tax

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Alaska
539
Election to Defer Tax
Federal EIN
Mailing Address
Name
Telephone Number
City
State
Zip
Purpose of form: The Election to Defer Tax declares that the buyer or transferee intends to purchase fuel to be placed
in a fuel storage facility that services both taxable and non-taxable purposes and that it qualifies to defer the payment of
Alaska Motor Fuel Tax.
Deferred Category
(Check one)
Air carrier purchasing fuel to be used in jet propulsion aircraft in both foreign and domestic flights. Purchaser
understands the requirement to file a tax return and remit any tax due on domestic flights by the last day of the month
in which fuel was used for such domestic flights.
DO NOT SEND THIS FORM TO THE DEPARTMENT OF REVENUE. THIS FORM MUST BE GIVEN TO THE SELLER.
Qualified municipality or a federally recognized tribe purchasing diesel for official use and resale to municipal residents
or tribal members. By checking this box, purchaser certifies that the fuel storage facility from which fuel may be
resold to municipal residents is situated in a community that is not located on the state highway system. Purchaser
understands that a tax return must be filed and any tax due on taxable sales must be paid by the last day of the month
in which such taxable sales occurred.
SEND THIS FORM TO THE DEPARTMENT OF REVENUE.
This deferral is effective for all purchases of fuel until revoked in writing by the purchaser to the seller.
Purchaser’s sworn statement: The undersigned understands that the fraudulent use of this certificate will subject all
guilty parties, upon conviction, to a fine not to exceed $25,000 or imprisonment for not more than three years, or both,
under AS 43.05.290. The undersigned shall, upon request, supply satisfactory evidence establishing the purpose for
which the fuel was or will be used.
I declare under penalty of unsworn falsification that I have examined this certificate and to the best of my knowledge and
belief it is a true, correct and complete statement. I understand that I am liable for the applicable motor fuel tax on any fuel
used for a taxable purpose.
Signature of Purchaser
Printed Name
Title
Date
Mail to:
ALASKA DEPARTMENT OF REVENUE
TAX DIVISION
PO BOX 110420
539
JUNEAU AK 99811-0420
Phone 907-465-2320 • Fax 907-465-2375
0405-539 Rev 07/12 - page 1

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