Alberta Form At4805 – Fill Out and Use This PDF

The Alberta AT4805 form serves as a declaration for individuals registered under the Indian Act, aged 16 and above, or for Indian Bands, to apply for the Alberta Indian Tax Exemption Card. This card allows for the purchase of fuel and tobacco free of provincial tax on Indian Reserves in Alberta, a benefit administered by the Alberta Treasury Board and Finance. To complete your application for tax exemption, click the button below to fill out your form now.

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Alberta Form At4805 PDF Details

At the heart of ensuring fair and tailored fiscal policies for Indigenous communities in Alberta lies the Alberta Indian/Indian Band Declaration Alberta Fuel and Tobacco Taxes form, also known as the AT4805 form. This vital document serves as a cornerstone for registered Indians and Indian Bands, enabling them to obtain the Alberta Indian Tax Exemption Card. This card is indispensable for those aged 16 and over wishing to purchase fuel or tobacco without the provincial tax on Indian Reserves, provided the stores are registered with Alberta Treasury Board and Finance. Completing and submitting this form to the Tax and Revenue Administration signifies a critical step toward exercising this fiscal privilege, designed with a dual purpose: to respect the autonomy of Indigenous communities and to streamline the tax exemption process for eligible purchases. Candidates for this exemption must specify the nature of their application—be it for a first card, a replacement, or an address change—while also ensuring thoroughness in providing personal details to avoid processing delays. The form not only captures essential identification information but also includes a solemn declaration to uphold the terms of tax exemption. It embodies a systematic approach by the Alberta government in managing tax exemptions, reinforcing a commitment to recognizing Indigenous rights while ensuring the integrity of tax administration.

Question	Answer
Form Name	Alberta Form At4805
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	Exemption, Aug-12, exemptions, ALBERTA

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ALBERTA INDIAN/INDIAN BAND DECLARATION

ALBERTA FUEL AND TOBACCO TAXES

Tax and Revenue Administration

This Declaration form may be completed by an Indian who is registered under the Indian Act, who is 16 years of age or older; or by an authorized signing officer on behalf of an Indian Band with all or part of its reserve located in Alberta or with an office in Alberta. Once approved, Alberta Treasury Board and Finance will issue an Alberta Indian Tax Exemption Card, which you must present to purchase fuel or tobacco free of provincial tax on Indian Reserves from stores which are registered with Alberta Treasury Board and Finance.

Send the completed form to: TAX AND REVENUE ADMINISTRATION, 9811 109 ST, EDMONTON AB T5K 2L5. If you have any questions, telephone 780-427-3044. If calling long distance within Alberta, call 310-0000 then enter 780-427-3044. Fax 780-427-0348

A. Type of Applicant:	Individual
(please check one)	OR	Band Name:
(please check one)		Band Name:

	Indian Band	Name:
		Name:

	Band Number:
	Band Number:

If type of applicant is "Indian Band", complete only item 5 and the Declaration box.

For Office Use Only

B.Reason for Application:

First Card	OR	Address Change	OR	Replacement Card
		Only		CHECK ONE BOX TO
				CHECK ONE BOX TO
				INDICATE THE REASON:

If you had an Alberta Indian Tax Exemption Card before, please specify the name used on your prior card.

Stolen

Damaged

Lost

Name Change

Expired

Same, or

1.Your Registry Number:

(If not known, please call your band office)

Must be 10 digits

Y Y Y Y M M D D

2.	Date of Birth:
2.	Date of Birth:

	(Note: If the Registry Number and Date of Birth are not completed, the Declaration form will be returned to you.)
3.	Last Name:
		Middle
4.	First Name:	Name(s):

Apt. #

5.Mailing Address:

City/Town:Province:

Area Code

Postal Code:

Telephone Number:

DECLARATION: I HEREBY DECLARE AND AGREE THAT

1.The information given on this form is true and correct.

2.I am the person described on this form or the person designated to sign on behalf of the band.

3.The fuel and/or tobacco that I will buy free of provincial tax will not be resold.

4.The information provided on this form may be communicated to retailers who sell fuel and/or tobacco on Indian reserves, for the sole purpose of administering exemptions from tax.

Signature:

Date:

(Note: This Declaration form must be signed. If it is not signed, this form will be returned to you.)

If the applicant signs with an "X", then someone 18 years of age or older, who knows the applicant must witness the mark.

Witness:

Date:

Personal information is collected on this form for the purpose of administering the Fuel Tax Act and the Tobacco Tax Act. It is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act. Questions about the collection of this information should be directed to the telephone numbers and address listed at the top of this form.

AT4805 (Aug-12)

Form authorized and prescribed by the President of Treasury Board and Minister of Finance

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Alberta Form At4805 – Fill Out and Use This PDF

Alberta Form At4805 PDF Details

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