Form 522 - Cigarette And Tobacco Products Monthly Tax Return (Page 4 of 8) in pdf

Form 522 - Cigarette And Tobacco Products Monthly Tax Return Page 4

522

Schedule F

Alaska Cigarette Transactions

Do not report other tobacco products here. Use Schedule G to report other tobacco products.

License Number

Name of Licensee

Period Ending (yyyymm)

Federal ID

You must complete this schedule if you manufactured, imported, acquired or sold cigarettes in the state during the month covered by this

return. Use a separate schedule for each type of transaction that applies to your business identified in boxes A through E below. Use

additional pages as necessary. All invoices supporting transactions identified in boxes A through E must be attached to this schedule to

constitute a complete filing.

Check one:

A. Cigarettes manufactured, imported, acquired or sold

B. Cigarettes sold to military

C. Cigarettes sold to Metlakatla Indian Reservation or Klawock Smoke Shop

D. Unstamped cigarettes returned to manufacturer. You must attach an affidavit from the manufacturer supporting the

number of cigarettes returned. Do not report the return of stamped cigarettes on this schedule. Use Schedule J.

E. Unstamped cigarettes destroyed. You must attach U.S. Treasury Department Form ATF-F 5200.7 or certification

from the manufacturer attesting to the destruction. Do not report the destruction of stamped cigarettes on this

schedule. Use Schedule J.

Invoice date

Name of supplier or purchaser

Invoice number

Number of cigarettes

TOTALS CARRIED FORWARD FROM PREVIOUS PAGE(S)

Total

Page number

_______

522

0405-522 Rev 09/12 - page 4

Form 522 - Cigarette And Tobacco Products Monthly Tax Return Page 4