Form 522 - Cigarette And Tobacco Products Monthly Tax Return Page 2
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8522
Schedule C
Alaska Report of Out-of-State Sales of Cigarettes
Complete a separate form for each state in which cigarettes were sold
License Number
Name of Licensee
Federal ID
Physical location in Alaska from where cigarettes were shipped
Address
City
State
ZIP+4
Contact Telephone
This schedule must be attached to the Alaska Cigarette and Tobacco Products Monthly Tax Return, Form 522. Use this schedule to report
stamped and unstamped cigarettes sold outside of Alaska. A cigarette licensee may maintain unstamped cigarettes in Alaska and/or claim
a credit for Alaska stamped cigarettes if its business includes sales to customers outside of Alaska and the licensee is properly licensed
in the state where the cigarettes are sold.
Cigarettes transferred or sold into (list state)
Are you licensed in the state where cigarettes were sold or transferred?
License Number
Yes
No
Column descriptions
5. Number of packages of 20 cigarettes per pack.
1. Date of shipment or transfer out of state.
6. Number of packages of 25 cigarettes per pack.
2. Indicate how shipped: DT (Distributor Transport);
7. The total number of sticks per invoice.
CC (Common Carrier); CT (Customer Transport).
8. Indicate if you paid tax to the state where the cigarettes were
3. Invoice number of product shipped into another state.
shipped.
4. Complete name, address and city of company or person to
9. Indicate whether cigarettes were affixed with the Alaska tax
whom cigarettes were sold.
stamp. If yes, complete Schedule J to claim a credit.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
# of Packs
# of Packs
# of Cigarettes
Affixed with AK
Date
Shipping
Invoice
Name and Address
Tax paid
shipped
method
number
20s
25s
(total sticks)
(yes/no)
tax stamp?
(yes/no)
522
0405-522 Rev 09/12 - page 2
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