Form 0405-681 - Alaska Fishery Resource Landing Tax Return Cdq Credit Application
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681
Alaska Fishery Resource Landing Tax Return
CDQ Credit Application
Due January 31 of the year following the year of contribution
Year of Contribution
Federal
EIN
SSN
Taxpayer name
Phone number
Fax number
Doing business as
Email address
Mailing address
Contact person
City
State
Zip + 4
Date of contribution
Name of nonprofit corporation receiving the contribution (recipient)
Recipient address
Recipient phone number
Intended use of the contribution*
Amount
Scholarships
Seafood industry training
* All contributions must be fisheries related.
Refer to AS 43.77.040 for further definition
Transportation facilities grants
of criteria that qualify contributions for a
Transportation facilities loans
community development quota (CDQ) credit.
Facilities grants
Facilities loans
Research grants
Total contributions
0
Have you or a related person received a loan or grant from any nonprofit corporation to whom you made a contribution?
Yes
No
Does your company have a direct or indirect ownership interest in the nonprofit corporation that received your contribution?
Yes
No
If Yes, indicate the percentage owned __________%
Does the nonprofit corporation that received your contribution have a direct or indirect ownership interest in your company?
Yes
No
If Yes, indicate the percentage owned __________%
You must attach the following documents and information before this application may be approved (failure to file a timely and complete
application as required by AS 43.77.040 constitutes a waiver of the credit).
1. A receipt from the nonprofit corporation verifying the date and amount of the contribution. Note: only cash contributions made as
donations qualify for the credit.
2. A statement from the nonprofit corporation specifying how the contribution will be used and an agreement by the nonprofit corporation
to allow the Tax Division to audit all of its accounts relating to the contribution.
3. The fishery resources, by unprocessed weight and species, harvested under CDQ.
4. A statement from you that the contribution to the nonprofit entity was expressly conditioned upon its use exclusively for the purposes
indicated above as authorized by AS 43.77.040.
5. A copy of the current harvest/royalty agreement between you and the CDQ holder.
Signature
Print name
Date
Department signature
Date
Department use only: Approved
Disapproved
Printed name
Title
Mail to: Alaska Department of Revenue
Tax Division
PO BOX 110420
681
0405-681 Rev 09/10 • page 1
JUNEAU AK 99811-0420
Retain a copy for your records
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