A description of the qualified business entity s business activities
A description of the qualified business entity s business in Alaska
A statement with your estimate of the amount of taxes due by tax period Show the accompanying computations
If the entity is a partnership or LLC the number of corporate partners or members
The facts giving rise to the offer to enter into a Voluntary Disclosure Agreement
The settlement terms proposed by the company
Whether the DOR has contacted the entity and if so the nature of such contacts
0405 6750 Rev 01/01/14
550 W 7th Ave Ste 500
6750:01/01/14
907 269 6620
907 269 6644
a settlement under Alaska s Voluntary Disclosure Program and that the information in this application including accompanying schedules and
Alaska Application For Voluntary Disclosure
Anchorage AK 99501 3555
Attach the following information to the application:
City State Zip Code
Corporation
Department of Revenue Tax Division
Department of Revenue?
dor tax disclosure@alaska gov
Entity Type:
Fax Number
Form 6750
Has the entity ever been the subject of an inquiry by
Has the entity ever filed an income tax return with the
I declare under penalty of perjury under the laws of the State of Alaska that I am authorized by the unnamed entity to act as its agent in negotiating
income taxes?
LLC (Limited Liability Company)
Mailing Address
Part I
Part II
Part III
Part IV
Partnership
Person Completing Form (Print Name)
Questions? Email
Representative s Email Address
Representative s Fax
Representative s Mailing Address
Representative s Name
Representative s Telephone Number
S Corporation
Signature
State Agency
statements is true and correct to the best of my knowledge and belief
Tax Periods:
Telephone Number
the Department of Revenue with respect to liability for
