Form 04-578 - Alaska Fisheries Business Tax Return - 1999

1999 Alaska Fisheries Business Tax Return

Page _____ of _____

DEPT USE ONLY

Alaska Department of Revenue

Income and Excise Audit Division

FSN

PO Box 110420

Juneau, Alaska 99811-0420

Telephone 907.465.3775

Fax 907.465.2375

Due Date: March 31, 2000

Federal EIN or SSN

Telephone Number

Fax Number

Individual or Corporation Name

E-mail Address

Business Name

Contact Person

Title

Mailing Address

Check if:

Amended (attach explanation)

Make checks payable to:

City

State

Zip Code

Alaska Department of Revenue

A. Fisheries

B. Facility Location or Vessel Name

C. Value of Seafood Products (from

DEPARTMENT

Bus. Lic No.

Page 2 of each Fisheries Return)

USE ONLY



1. Total value of seafood products listed in column C. (If less than $50,000,

skip lines 2 - 5, sign the return, and file it on or before the due date)……………… 1

2. Assessment. Multiply the value on line 1 by .3% (.003)………………………………2

Amount Due



3. Add penalty for late filing (see instructions)…………………………………………… 3



4. Add penalty for late payment (see instructions)……………………………………… 4



5. Interest (11% compounded quarterly)………………………………………………… 5



6. Total amount due (add lines 2, 3, 4, and 5)…………………………………………… 6

Please note: If your aggregate tax payment is greater than $150,000, you must wire transfer the funds in accordance with 15 AAC 05.310. See instructions for details.

Check here if you are remitting by wire transfer or electronic funds transfer.

I declare under penalty of unsworn falsification that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is

true, correct, and complete. If prepared by a person other than the taxpayer, preparer's declaration is based on all information of which preparer has any knowledge.

Signature

Type or Print Name

Date

DEPARTMENT USE ONLY

VALIDATION

PMD:

Form 04-578 (Rev 11/99)