Page 1 of 2
                                                CITY OF UNALASKA
                                           PO BOX 610 UNALASKA, AK 99685
                                      Phone (907) 581-1251     Fax (907) 581-1417 
                                                  www.ci.unalaska.ak.us

                                                SALES TAX REPORT
                   QTR1 o         QTR2 o                      QTR3 o       QTR4 o
     QTR ENDING     March 31      June 30                     September 30 December 31                                                         YEAR __________________
                  DUE April 30    DUE July 31       DUE October 31         DUE January 31 
                 
     NAME:                                                                 BUSINESS LIC. #
     ADDRESS:
                                                                                           Final Report, Close Business License               o

     DETERMINATION OF ADJUSTED GROSS RECEIPTS
     1.  GROSS RECEIPTS FOR QUARTER(INCLUDING     SALES TAX COLLECTED)
         A.    RENTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ____________________
         B.    SALES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________
         C.    SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________
         D.  TOTAL GROSS RECEIPTS (Add A through C) . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . .                  $ _______________________
     2.  NON-TAXABLE RECEIPTS (Complete Page 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________________
     3.  ADJUSTED GROSS RECEIPTS (Subtract Line 2 from 1D)    . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . $ _______________________

     DETERMINATION OF TAXABLE RECEIPTS
     4.  DIVIDE LINE 3 BY 1.03 (TAXABLE GROSS RECEIPTS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________________

     DETERMINATION OF TAX DUE
     5.  MULTIPLY LINE 4 BY .03 – SALES TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________________
     6.  CREDIT OR AMOUNT DUE FROM PREVIOUS REPORTS . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . $ _______________________
     7.  CREDIT FOR SALE FOR RESALE REFUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________________
     8.  TAX DUE (Line 5, plus or minus Line 6, minus Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ _______________________
     9.  PENALTY AND INTEREST DUE (If applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . .  $ _______________________
     10. TOTAL DUE (Line 8 plus Line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______________________

     Sales Tax Reports must be filed on a quarterly basis, due on the last day of the month following the end of a quarter. This report
     is invalid unless completed in detail and signed. Report must be filed even if there were no receipts for the quarter.  Delinquent
     reports incur a penalty of 5% per month or fraction thereof up to 20%, plus interest at 15% per annum. Failure to file is a minor
     offense with the fines established by code up to $500 per violation or day. The City’s additional remedies for violations of sales
     tax ordinances are set out in Unalaska Code of Ordinances 6.40.100.

     I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT.

     SIGNATURE                                      TITLE                                                                                 DATE

     PRINTED NAME                                   EMAIL ADDRESS

           COMPLETED SALES TAX REPORT MAY BE EMAILED TO CITY CLERK MARJIE VEEDER AT mveeder@ci.unalaska.ak.us

                                                                                                                 Page 2 of 2

                  CITY OF UNALASKA SALES TAX REPORT

Name                                        Quarter Ending: ____________________

License #

                             NON-TAXABLE TRANSACTIONS

1.  SALES TO CITY OR OTHER GOVERNMENT AGENCIES 6.40.030(L)                                                $ ________________________
         SOLD TO:                                                                                         AMOUNT:
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________

2. SALES RELATED TO CITY PUBLIC WORKS PROJECTS 6.40.030 (AA)                                              $ ________________________
         SOLD TO:                                                                                         AMOUNT:
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________

3. SALES NOT "MADE IN THE CITY" 6.40.010(C)                                                               $ ________________________
         SOLD TO & LOCATION:                                                                              AMOUNT:
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________
         _________________________________________________________                                        _________________________

4.  ALL OTHER SALES CLAIMED EXEMPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          $ ________________________
                                      City Sales Tax Exemption Certificate Number 
                                            or other justification
         SOLD TO:                                                                                         AMOUNT:
         _____________________________         ______________________________                             _________________________
         _____________________________         ______________________________          _________________________
         _____________________________         ______________________________          _________________________
         _____________________________         ______________________________          _________________________

TOTAL ALL NON-TAXABLE TRANSACTIONS          . . . . . . . . . . . . . .          $ _________________________