Form 876 - Alaska Request For Gaming Information printable pdf download

Form 876 - Alaska Request For Gaming Information

Alaska

876

Request for Gaming Information

Name and Address

Daytime Telephone Number

What information are you requesting? Be specific as to what forms (or portion thereof) and what time period you are

interested in. Delays will occur if it is not clear what information you desire.

In accordance with 6 AAC 95.130(a), I understand that I must pay a fee of $0.25 per page for this service. If the time

required to search out and copy documents for a single requester exceeds five hours in a calendar month, the department

is authorized to charge the requester an hourly rate equal to the searcher’s hourly rate plus benefits for those hours in

excess of five hours. If the time required to search out and copy documents for a single requester exceeds a single

employee’s work hours in a calendar month, the department is authorized to charge the full salary costs of the searcher.

I understand that once the research has been performed and the copies have been made, gaming personnel will contact

me and I must send in payment for these services before I can receive the copies. All requests are processed on a first

come, first served basis. Please allow 4 to 6 weeks processing time.

I have read the above statement and by my signature below, agree to and authorize the Tax Division to perform a search

for the information that I have requested.

Requestor Signature

Requester Printed Name

Date

DEPARTMENT USE ONLY

Mail to: ALASKA DEPARTMENT OF REVENUE

Date Received

TAX DIVISION - GAMING GROUP

PO BOX 110420

Date Processed

JUNEAU AK 99811-0420

Phone 907-465-2320 • Fax 907-465-3098

876

Retain a copy for your records

0405-876 Rev 08/11

Form 876 - Alaska Request For Gaming Information