Form 0405-662 - Mining License Tax Return - 2013
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7Alaska
662:10 04 13
2013 Mining License Tax Return
662
Taxpayer Name (must agree to mining license application)
If fiscal year filer, enter year end
Month ________________
Day ________________
Return Information (check all that apply)
SSN
Telephone Number
FEIN
First Return
Amended Return
(attach explanation)
Business Name (dba)
Final Return
Check if new address
Mailing Address
Contact Person
Title
City
State
Zip Code
Contact Telephone
Contact Email Address
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Taxable income from all mining operations (line 8 of all Schedule As)
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2
Tax (see instructions)
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3
Exploration incentive credit (attach Form 665)
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4
Mining business education credit (line 6 of Schedule EC)
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5
Tax before other credits (subtract lines 3 and 4 from line 2, but not less than zero)
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Film production tax credit (cannot exceed line 5, attach certificate or explanation of carry forward)
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Amount paid with extension
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Amended returns only. Amount paid with original return
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Net tax due or (overpayment). (subtract lines 6, 7 and 8 from line 5)
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Electronic Payment Information
Note: If your liability is $150,000 or more, you must pay online at
I declare under penalty of perjury that this return, including all accompanying schedules and statements, has been examined by me and to the best of my
knowledge and belief is a true, correct, and complete return.
Signature
Printed Name and Title
Date
Pay online at
or make check payable to State of Alaska
662
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-662 Rev 10/04/13 - page 1
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