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                                        BOROUGH AND CITIES JOINT SALES TAX RETURN
                                                                                        Kenai Peninsula Borough
             58195                                 144 North Binkley, Soldotna, Alaska 99669-7520
                                                   (907) 714-2175 or (800) 478-4441 ext. 2175
                                                                                           www.kpb.us/salestax                   For Filing Period Ended              Registration #
     Request to pre-file No Sales (1 year maximum)
     From Period                        Thru Period
                                                                                                                                  M   M         Y     Y    Y     Y
                                                                                         RETURN HAS NO SALES
                                                                                                                  DBA:
     No longer conducting business.                                                      Corrected
     Date Business
     Sold or Closed:                 /         /                                         Amended                             DUE BY:
                                M    M            D    D           Y     Y     Y    Y
     Business Sold To:
                                                                                        ONLY ROUND SALES FIGURES TO THE NEAREST DOLLAR (for lines 1, 2, and 3)
JURISDICTION CODE
(from Table)                                       9 9
1. GROSS SALES
    (NOT INCLUDING SALES TAX)                  ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
2. NON-TAXABLE SALES
A) Sales outside the Borough
                                               ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
B) Sales for Resale
                                               ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
C) Government Agencies
                                               ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
D) Excess of Individual Sales
     Over $500.00                              ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
E) Non-Prepared Food
                                               ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
F) Other (Specify)
                                               ,   ,                                   .00                ,       ,          .00                          ,           ,  .00

G) TOTAL NON-TAXABLES
                                               ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
3. TAXABLE SALES
     (LINE 1 MINUS LINE 2G)                    ,   ,                                   .00                ,       ,          .00                          ,           ,  .00
4. ENTER TAX RATES
     (rate from table)                             3 0 0.                            %                          .     %                                           .     %
5. SALES TAX - DO NOT ROUND                    ,   ,                                   .                  ,       ,          .                            ,           ,  .
6. TOTAL SALES TAX
   (ALL JURISDICTIONS, Front & Back)           ,   ,                                   .                              FOR OFFICE USE ONLY
7. ADJUSTMENTS                          $1000 MAX PER QUARTER; MUST BE IN COMPLIANCE
A) CREDIT FOR PROMPT                                                                                      Cash                      ,                             ,     .
     REMITTANCE (5% OF LINE 6)                 ,   ,                                   .
B) PENALTY FOR LATE                                                                                       CK#                       ,                             ,     .
     REMITTANCE                                ,   ,                                   .
C) INTEREST / OTHER                                                                                       CK#
                                               ,   ,                                   .                                            ,                             ,     .
D) PREVIOUS BALANCE DUE                                                                                   E-Check
                                               ,   ,                                   .                                            ,                             ,     .
8. TOTAL DUE                                                                                              Credit Card               ,                             ,     .
                                               ,   ,                                   .
9. TOTAL REMITTED                                                                                                 Total Remitted    ,                             ,     .

     Jurisdiction                    Code Rate Additional Jurisdiction                                    Notes:
     Seldovia - Winter               10 2.00%  Entry Blocks on the Back.
       (October - March)                       Use only if needed.
     Seldovia - Summer               11 6.50%
       (April - September)
     Homer                           20 4.85%
     Kenai                           30 3.00%
     Seward                          40 4.00%
     Soldotna                        70 3.00%
     Soldotna - Marijuana            75 1.50%
     Borough                         99 3.00%
OWNER / AGENT               I declare, subject to the penalties prescribed that this return (including any
                            accompanying statements) has been examined by me and to the best of my
                            knowledge and belief is a true, correct and complete return.
                                                                                                          SIGNATURE REQUIRED                                      DATE

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                                                                For Filing Period Ended       Registration #
                                                    Page 2

                58195
                                                            DBA:

                                          ONLY ROUND SALES FIGURES TO THE NEAREST DOLLAR (for lines 1, 2, and 3)
    JURISDICTION CODE
    (from Table)
1. GROSS SALES
    (NOT INCLUDING SALES TAX)           ,   ,   .00 ,       ,   .00                         ,                   ,  .00
2. NON-TAXABLE SALES
A) Sales outside the Borough
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
B) Sales for Resale
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
C) Government Agencies
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
D) Excess of Individual Sales
     Over $500.00                       ,   ,   .00 ,       ,   .00                         ,                   ,  .00
E) Non-Prepared Food
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
                                        ,   ,   .00                                         ,                   ,  .00
    F) Other (Specify)                              ,       ,   .00

G) TOTAL NON-TAXABLES                   ,   ,   .00 ,       ,   .00                         ,                   ,  .00
3. TAXABLE SALES
     (LINE 1 MINUS LINE 2G)             ,   ,   .00 ,       ,   .00                         ,                   ,  .00
4. ENTER TAX RATES
     (rate from table)                    .   %           .   %                               .                   %
5. SALES TAX - DO NOT ROUND
                                        ,   ,   .   ,       ,   .                           ,                   ,  .

JURISDICTION CODE
(from Table)
1. GROSS SALES
    (NOT INCLUDING SALES TAX)           ,   ,   .00 ,       ,   .00                         ,                   ,  .00
2. NON-TAXABLE SALES
A) Sales outside the Borough
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
B) Sales for Resale
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
C) Government Agencies
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
D) Excess of Individual Sales
     Over $500.00                       ,   ,   .00 ,       ,   .00                         ,                   ,  .00
E) Non-Prepared Food
                                        ,   ,   .00 ,       ,   .00                         ,                   ,  .00
F) Other (Specify)                                  ,       ,   .00                         ,                   ,  .00
                                        ,   ,   .00

G) TOTAL NON-TAXABLES                   ,   ,   .00 ,       ,   .00                         ,                   ,  .00
3. TAXABLE SALES
     (LINE 1 MINUS LINE 2G)             ,   ,   .00 ,       ,   .00                         ,                   ,  .00
4. ENTER TAX RATES
     (rate from table)                    .   %           .   %                               .                   %
5. SALES TAX - DO NOT ROUND
                                        ,   ,   .   ,       ,   .                           ,                   ,  .

     Jurisdiction             Code Rate
     Seldovia - Winter        10   2.00%
       (October - March)
     Seldovia - Summer        11   6.50%
       (April - September)
     Homer                    20   4.85%
     Kenai                    30   3.00%
     Seward                   40   4.00%
     Soldotna                 70   3.00%
     Soldotna - Marijuana     75   1.50%
     Borough                  99   3.00%

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