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2. Account # AND Business Name *
   Please include your Business Name and Account number.
4. For Period Ending *
   mm/dd/yyyy
5. Report Type*

   1. Monthly
   2. Quarterly
7. 1. Gross Sales*
   Any false statement on this form is punishable under AS 11.56.210.
9. 2. Exempt Sales

   Select any or all that apply

   1. Less Employer 90-Day
   2. Less Monthly 30-Day
   3. Less Other Non-Taxable Sales
11. A. Less Employer 90-Day
    Exempt Sales (Must Provide Backup)
12. B. Less Monthly
    30 Days or More Non-Taxable Sales (Must Provide Backup)
13. C. Less Other Non-Taxable Sales
    (Must Provide Backup)
15. 3. Total All Taxable Sales*
    (Line 1 - Lines 2A, 2B & 2C)
17. 4. Taxes Due *
    8 Percent (.08 x Line 3)
19. 5. Penalties A. 1 -Late Report
    Late Report Penalty ($25)
21. A. 2 - Late Remittance Penalty
    10 Percent of Line 4 (.10 X Line 4)
23. B. Additional Penalty or Fine
    (as Per FNSBC 1.04 & 3.58.090)
25. 6. Interest
    1.25 Percent Per Month (0.0125 X Line 4)
27. 7. Collection Compensation
    (if Paying Is Current) (.02 of Line 4, Not to Exceed $250)
29. 8. Total Liability *
    (Line 4 - Line 7), if Delinquent (Line 4-5A, 5B, 5C & Line 6)
31. 9. - Credit / + Liability
    Subtract Credit or Add Outstanding Liability
33. 10. Net Taxes Due *
    (Line 8 & Line 9)
35. Owner or Agent*
36. Email Address*
38. By submitting this form I declare (subject to the penalties prescribed) that this report, including any accompanying statements, has been examined by me and to the best of my knowledge and belief is a true, correct and complete report.
40. Backup for Exemptions
42. Request for Inactive Status
    Request must be received 30 days prior to inactive period. Inactive period must be a minimum of three months.
44. If this is a Final Report or there is a change of owner or address, please contact Treasury Budget at 907-459-1441. The Fairbanks North Star Borough does not allow or accept advanced filing of Hotel-Motel Room Tax Reports from any operator regardless of the circumstances.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field