Form 522 - Cigarette And Tobacco Products Monthly Tax Return (Page 5 of 8) in pdf

Form 522 - Cigarette And Tobacco Products Monthly Tax Return Page 5

Schedule G

522

Alaska Tobacco Products Transactions

Do not report cigarettes here. Use Schedule F to report cigarettes.

Federal ID

License Number

Name of Licensee

Period Ending (yyyymm)

You must complete this schedule if you manufactured, imported, acquired or sold tobacco products (other than 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 D below. Use additional pages as necessary. All invoices supporting transactions identified in boxes A through D must

be attached to this schedule to constitute a complete filing.

Check one:

A. Tobacco products manufactured, imported, acquired or sold. Enter on Schedule B, line 6.

B. Credit for military sales. Enter on Schedule B, line 7.

C. Credit for Metlakatla Indian Reservation or Klawock Smoke Shop sales. Enter on Schedule B, line 8.

D. Other credits - Unsaleable or destroyed tobacco products. You must attach an affidavit from the manufacturer or

distributor supporting the amount of tobacco products returned and/or U.S. Treasury Dept. Form ATF-F 5200.7

supporting the amount of tobacco products destroyed. Enter on Schedule B, line 9.

Invoice date

Name of supplier or purchaser

Invoice number

Tobacco products only

TOTALS CARRIED FORWARD FROM PREVIOUS PAGE(S)

Total

Page number

_______

522

0405-522 Rev 09/12 - page 5

Form 522 - Cigarette And Tobacco Products Monthly Tax Return Page 5