Form 526 - Jenkins Act Report Of Cigarette Sales To Persons In Alaska

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Alaska
526
Jenkins Act* Report of Cigarette Sales
to Persons in Alaska
Due Date: 10th day of the calendar month following the month in which cigarettes were shipped to the State of Alaska.
Federal EIN
Telephone Number
Trade Name (DBA/AKA)
Contact Person
Title
Mailing Address
Email Address
City
State
Zip Code
Contact Phone Number
.
Shipments of cigarettes into the State of Alaska for the month ending
Attach additional sheets as needed.
Invoice
Invoice
Cigarettes Shipped to: Name
Cigarettes Shipped to: Address
Cigarette
Number of
Date
Number
Brand
Cigarettes
Signature of Preparer
Date
*
Jenkins Act: Title 15 U.S. Code, the Jenkins Act, requires that any person who sells or transfers cigarettes for profit into Alaska, to
other than a distributor licensed by the Department of Revenue (DOR), must file a memorandum with DOR showing each and every
shipment of cigarettes made into Alaska during the previous calendar month. The memorandum, which is due no later than the 10th
day of each month, must include the name and address of the person to whom the shipment was made and the quantity of cigarettes.
526
Mail to: Alaska Department of Revenue, 550 W 7th Ave STE 500, Anchorage AK 99501-3555
0405-526 Rev 08/12

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