Form 04-566 - Salmon Enhancement Tax Monthly Return
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1DOR USE ONLY
Salmon Enhancement Tax
Mail original to:
ENVELOPE #:
Department of Revenue
MONTHLY RETURN
Tax Division
FSN:
AS 43.76
PO Box 110420
Juneau AK 99811-0420
For tax periods after 12/31/04
Year
Month
Telephone 907. 465.3775
Fax 907. 465.3566
This form is available online at:
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
Part 3. Exempt Purchases
(Required Information - See instructions)
A.
B.
Use this section to report all salmon harvested under a
Region
Pounds of Salmon
Value of Salmon
special harvest area entry permit issued under AS
16.43.400.
1. Southern Southeast
$
Example:
Salmon
purchased
from
government
agencies, salmon hatcheries or a fishing derby.
2. Northern Southeast
$
3. Prince William Sound
$
Pounds of Salmon
Value of Salmon
4. Cook Inlet
$
5. Kodiak
$
1.
2. $
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.
D.
Region
Pounds of Salmon
Value of Salmon
Tax Rate
Tax (Column B x C)
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
(Totals on line 8, columns A and B must equal totals on line 16, columns A and B)
$
Total tax liability due
17
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:
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 04-566 Webform (Rev 3/05)
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