Form 500 - Alcoholic Beverage Excise Tax Return Page 3
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7Alaska
500
Alcoholic Beverage Excise Tax Return
Business Name
Month and Year
Page ______of
______
Licensed Location
DOR License Number
Schedule C:
Gallons Sold to Military Establishments
This is a supporting schedule of tax exempt gallons sold in Alaska to military establishments that meet all requirements for
tax exempt status as defined in U.S.C. 4-107. The total must be reported on line 5 of Schedule G, the Inventory Report. Use
additional sheets as necessary.
Number of Gallons
Judicial
Qualified
Beer, Malt
Name AND Alaska address of tax exempt sales to
District (des-
Reduced Tax
Liquor
Wine
Beverages &
Qualified Military Establishments.
tination of
Rate Beer &
Cider
Malt Beverages
military sale)
0.000
0.000
0.000
0.000
Totals:
500
Retain a copy for your records
0405-500 Rev 12/10 • page 3
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