Form 401 - Alcoholic Beverage Excise Tax License Application
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1Alaska
401:08 02 13
401
Alcoholic Beverage Excise Tax
License Application
Is this a renewal?
License Number Lic. Year ABC Board License Number
FEIN
Brewery
Distillery
Yes
No
SSN
Direct Distributor
Winery
Taxpayer Name
Business Name
Mailing Address
Email Address
Business Telephone
City
State
ZIP Code
Physical location where this license is applicable
Contact Person
Contact Telephone
Contact Email Address
Business Owner’s Name
Contact Telephone
Business Physical Address
City
State
Zip Code
Name of personnel who may authorize immediate inspection of the licensed business. Use additional pages as necessary.
Estimated Maximum Monthly Tax Calculation
Estimated maximum monthly
Alcoholic beverages excise
production for license year
Excise tax
tax rates
(gallons)
Liquor
X
$12.80
=
Wine & other
X
$2.50
=
Beer, cider & malt beverages
X
$1.07
=
Beer (qualified for reduced rate)
X
$0.35
=
Total estimated maximum monthly tax
=
Your estimated maximum monthly tax liability must be secured by a surety bond or at its discretion, DOR may issue a permit
in lieu of a bond.
Surety Bond in the amount of $25,000. Attach the Alcoholic Beverages Surety Bond (Form 405).
Permit in lieu of bond (cash, letter of credit or certificate of deposit from an Alaska Bank in an amount equal to the total estimated
maximum monthly tax indicated above). You must be doing business wholly in the state of Alaska to qualify. For new applicants,
attach a written request for permit in lieu of bond.
I declare under penalty of unsworn falsification that this application and any attachments have been examined by me and to the
best of my knowledge and belief are true, I agree to pay all alcoholic beverage excise taxes imposed by AS 43.60. I agree to file a
monthly tax return.
Signature of Applicant (must be an owner or corporate officer)
Printed Name
Date
Pay online at
Online payment receipt # ________________
or make check payable to State of Alaska
401
Mail to: Alaska Department of Revenue, 550 W 7th Ave STE 500, Anchorage AK 99501-3555
0405-401 Rev 08/02/2013
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