Form 04-587 - Salmon Enhancement Tax Bonus Return
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1Salmon Enhancement Tax
BONUS RETURN
AS 43.76
DOR USE ONLY
Mail original to:
ENVELOPE #:
Department of Revenue
For tax periods after 12/31/04
Tax Division
PO Box 110420
FSN:
Juneau AK 99811-0420
This form is available online at:
Telephone 907.465.3775
Calendar year in which resources were originally
Month/Year additional payment made:
Fax 907.465.3566
purchased or exported.
Year:
Month:
Federal EIN or SSN
Fisheries Business License Number
Individual or Corporation Name
Facility Location or Vessel Name
Business Name
Telephone Number
Mailing Address
Fax Number
City
State
Zip Code
E-mail Address
Contact Person
Title
Check if amended return (attach explanation)
Part 1. Region Where Caught
(Required Information - See instructions)
A.
Region
Additional Value of Salmon
1. Southern Southeast
$
2. Northern Southeast
$
3. Prince William Sound
$
4. Cook Inlet
$
5. Kodiak
$
6. Chignik
$
7. Outside aquacultural region
$
8. TOTAL
$
(add lines 1-7)
Part 2. Salmon Enhancement Tax - Region Where Purchased or Exported From
A.
B.
C.
Region
Additional Value of Salmon
Tax Rate
Tax (Column A x B)
Department Use Only
9. Southern Southeast
$
3% (.03)
9
10. Northern Southeast
$
3% (.03)
10
11. Prince William Sound
$
2% (.02)
11
12. Cook Inlet
$
2% (.02)
12
13. Kodiak
$
2% (.02)
13
14. Chignik
$
2% (.02)
14
15. Outside aquacultural region
$
N/A
15
16. Total
$
N/A
(add lines 9-15)
16
(Total on line 8, column A must equal the total on line 16, column A)
$
Total tax liability due
17
17.
(from line 16, column C) ...........................................................
Note: If your total liability exceeds $100,000, you must use the Tax OnLine Payment System (TOPS) or wire transfer funds.
Check if you are remitting by:
Wire Transfer
TOPS Confirmation Number_______________________________
I certify under penalty of unsworn falsification that this report, including all accompanying schedules and attachments, has been examined by me and
to the best of my knowledge and belief is a true and complete return.
Signature
Printed Name
Title
Date
DEPT USE ONLY
VALIDATION
PMD:
Form 04-587 Webform (Rev 3/05)
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