Form 0405-580 - Dive Fishery Management Assessment - 2014
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DEPARTMENT USE ONLY
Alaska
ENV
580
FSN
2014 Dive Fishery Management
Assessment
EIN
Fisheries Business License No.
SSN
Taxpayer Name
Business Location or Vessel Name
Mailing Address
Telephone Number
City
State
Zip Code
Fax Number
Contact Person
Email Address
Original Return
Amended Return (attach explanation)
Fisherman
Licensed Buyer
Year:
Quarter in which dive resources were purchased
Indicate the year the resource was exported from the state or
sold to an unlicensed buyer.
Quarter
Due Date
Jan - Mar
April 30, 2014
Year:
Apr - Jun
July 31, 2014
Jul - Sep
October 31,2014
Oct - Dec
February 2, 2015
The due date is March 31, 2015.
Bonus Return
Indicate above the year and quarter the resource was originally reported. Indicate below the month and year the bonus
payments were made.
Month:
Year:
The due date is the last day of the month following the month of the bonus payment.
A
B
C
D
Tax (Column B x C)
Pounds
Value
Rate
1
Geoduck
7% (.07)
2
Sea Cucumber
5% (.05)
3
Sea Urchin
7% (.07)
Total (add lines 1 through 3, Column D)
4
$
5
AMENDED AND BONUS RETURNS ONLY Taxes previously paid for this quarter/year
(
)
6
TOTAL TAX LIABILITY (REFUND) DUE (Subtract line 5 from line 4)
$
Electronic Payment Information
Note: If your liability is $100,000 or more, you must use the Online Tax Information System (OTIS) at or wire transfer.
Check if you are paying by:
OTIS confirmation #
Wire transfer date
I declare under penalty of unsworn falsification that this return, including all accompanying schedules and statements, has
been examined by me and to the best of my knowledge and belief is true and complete.
Signature
Printed name and title
Date
Department use only PMD
Validation
Pay online at or make check payable to State of Alaska
580
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-580 Rev 12/20/13
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