Form 04-623 - Application To Purchase Cigarette Tax Stamps On Deferred Payment Basis - Csed 04-1603
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1
2INSTRUCTIONS
Alaska Application to Purchase Cigarette Tax Stamps On a Deferred Payment Basis
General Instructions
Where to Send Form 04-623
Effective January 1, 2004, the cigarette excise tax
Form 04-623 must be mailed or delivered to the
authorized by AS 43.50 must be paid through the
Department of Revenue, Tax Division, 550 W. 7th
use of cigarette tax stamps. Cigarette tax stamps are
Avenue, Suite 500, Anchorage, AK 99501 or faxed
required to be affixed to packages of cigarettes
to 907.269.6644. After the application has been
before sale or distribution in the state. Cigarette
approved or denied, a copy will be returned to you.
licensees must pay for cigarette tax stamps at the
You may begin to make purchases of cigarette tax
time they are ordered unless they have prior written
stamps on a deferred payment basis only after the
approval from the Department to purchase cigarette
form is approved.
Generally, the approval will
tax stamps on a deferred payment basis. Form 04-
expire at the same time as the surety bond. You
623 is used to request approval to purchase cigarette
may also fax the form to 907.269.6644, however
tax stamps on a deferred payment basis.
final approval will not be given until the original
signed surety bond is received by the Department.
Specific Instructions
Payment Due Date
Determine the maximum dollar amount of cigarette
tax stamps you will want to purchase on a deferred
If you are approved to purchase cigarette tax stamps
payment basis each month. A surety bond in the
on a deferred payment basis, payment is due by the
amount of 200 percent of the maximum dollar
end of the month following the month in which you
amount requested must be obtained before the
purchased the tax stamps.
You should remit
Department will review your request.
payment with your monthly tax return, Form 04-
522. If you fail to make payment at the time due,
Beginning January 1, 2005, a licensee that holds a
we will assess all penalties and interest and
license issued under AS 43.50.010 for a physical
immediately suspend your privilege to purchase
location in Alaska and has been in full compliance
cigarette tax stamps on a deferred-payment basis.
with the provisions of AS 43.50 during the
preceding 60 months, may reduce the surety bond
Suspension of Deferred-Payment Basis Privilege
requirement to 100 percent of the maximum dollar
amount of cigarette tax stamps purchased on a
The Department may suspend, without prior notice,
deferred payment basis each month.
your privilege to purchase stamps on a deferred-
payment basis or reduce the monthly dollar amount
Complete Form 04-041D (Rev 10/03) and attach it
of purchases made on a deferred-payment basis for
to this request. Earlier versions of Form 04-041D
the following reasons:
will not be accepted. The surety bond executed
between you and the surety company on a form or
1. You fail to pay for stamps when payment is due.
in a format different from Form 04-041D may be
2. Your bond is cancelled or becomes void,
accepted provided that all information required on
impaired, or unenforceable.
Form 04-041D is provided.
3. The department determines that the collection of
an amount unpaid or due is jeopardized.
4. You violate a state statute or regulation related
Signatures
to the collection of taxes under this chapter.
Form 04-623 must be signed and dated by the
Questions
licensee and an authorized representative of the
surety company.
Unsigned forms will not be
If you have questions about this form, please
accepted.
contact the Tax Division at 907.269.6620.
Form 04-623 Instructions (Rev 12/04)
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