Form 210 - Commercial Passenger Vessel Excise Tax Monthly Return Page 4

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210
Taxpayer Name
Vessel Name
Period Ending (year/month)
Schedule D - Tax Reduction for Local Levies
Attach additional pages if needed
Voyage #
Alaska Port Code
Number of
Levy Amount
Levy Rate
(Schedule B)
(JNU or KTN)
Passengers
Collected
Subtotal
$ 0.00
Total from additional pages
Total levies collected (also enter on schedule A, line 4)
$ 0.00
210
0405-210 Rev 10/12 - page 4

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