Form 04-566 - Salmon Enhancement Tax Return - Alaska Departament Of Revenue

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purchased

For Tax Periods After 12/31/2004

Reset

Mail original to:

DEPT USE ONLY

Salmon Enhancement

Department of Revenue

Envelope #:

Tax Division

Tax Return

PO Box 110420

FSN:

Juneau AK 99811-0420

Telephone 907-465-2320

This form is available online at:

Fax 907-465-3566

Year/month salmon purchased

Check One

Note different due dates

Monthly tax - due last day of month following month of purchase

Year:

Month:

Buyer

Year salmon exported/sold

Year:

Fisherman

Yearly tax - due March 31st of following year

Amended Return

Year/month salmon purchased

Year/month bonus payment made

Bonus Return

Year:

Month:

Year:

Month:

(attach explanation)

Telephone Number

Fax Number

Fisheries Business License #

Federal EIN

or SSN

Individual or Corporation Name

Business Name

Mailing Address

City

State

Zip Code

Facility Location or Vessel Name

Part 1. Region Where Caught

(Required Information - See instructions)

E-mail Address

Region

Pounds of Salmon

Value of Salmon

1. Southern Southeast

2. Northern Southeast

Part 3. Exempt Purchases

Prince William Sound

Use this section to report all salmon harvested under a special harvest

area entry permit issued under AS 16.43.400.

4. Cook Inlet

Example: Salmon purchased from government agencies, salmon

hatcheries or a fishing derby.

5. Kodiak

6. Chignik

Pounds of Salmon

Value of Salmon

7. Outside

2. $

8. TOTAL

(add lines 1-7)

Part 2. Salmon Enhancement Tax - Region Where Purchased or Exported From

Tax (Column B x C)

Region

Pounds of Salmon

Value of Salmon

Tax Rate

9. Southern Southeast

3% (.03)

10. Northern Southeast

3% (.03)

11. Prince William Sound

2% (.02)

12. Cook Inlet

2% (.02)

13. Kodiak

2% (.02)

14. Chignik

2% (.02)

15. Outside

N/A

16. Total

(add lines 9-15)

N/A

(Totals on line 8, columns A and B must equal totals on line 16, columns A and B )

17. AMENDED AND BONUS RETURNS ONLY

Taxes previously paid for this period

(

)

TOTAL TAX LIABILITY (REFUND) DUE

18.

(subtract line 17 from line 16, column D)

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:

TOPS Confirmation Number____________________________

Wire Transfer

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 04-566 Webform (Rev 06/08)