Form 04-568 - Alaska Fisheries Business Monthly Payment And Report - Department Of Revenue
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1Alaska Fisheries Business Monthly Payment and Report
Form 04-568
Remit Payment to:
This form is available online at
Department of Revenue
Tax Division
PO Box 110420
Month
Year
Juneau, AK 99811-0420
Phone (907) 465-2320
Fax (907) 465-3566
For use by fisheries businesses electing a monthly payment option under AS 43.75.
Due: 15th day of the month following month of activity.
Individual or Corporation Name
Federal EIN or SSN
Fisheries Business License Number
Mailing Address
Facility Location or Vessel Name
City
State
Zip Code
Telephone Number
Fax Number
E-mail Address
Contact Person
Title
Fisheries
Pounds
Value
Rate
Business Tax
SALMON CANNERY
4.5%
$
SHORE BASED
Salmon
3%
$
Other Species - Established
3%
$
Other Species - Developing
1%
$
FLOATING
Salmon
$
5%
Other Species - Established
5%
$
Other Species - Developing
$
3%
Value
Tax
B
1. Totals…….…………………………………………............. A
………...........
2. ASMI Seafood Marketing Assessment (multiply box A x .005)………………………………… $
3. Salmon Enhancement Tax from line 16 of Form 04-566 (attach form)……………………….. $
4. Dive Fishery Management Assessment (see instructions)…………………………………….. $
5. Seafood Development Tax from line 5 of Form 04-582 (attach form).....................
$
6. Total monthly payment due (add lines 1B, 2, 3, 4 and 5)…………………………………………$
Note: If liability exceeds $100,000, you must use the Tax OnLine Payment System (TOPS) or wire transfer.
Check if remitting by:
TOPS - Confirmation No.'s for: FBT
ASMI _____________________
Wire Transfer/Wire Date _____________________
SET
DIVE _____________________
SD
To avoid wire transfer fees, use the Tax Online Payment System (TOPS) at
or call for information.
I declare under penalty of unsworn falsification that the information provided in this return has been reviewed by me, and to
the best of my knowledge and belief is true, correct, and complete. I understand that failure to pay all amounts required
under AS 43.75.055(c) may result in the suspension of this fisheries business license and termination of security under this
monthly payment option.
Signature of Taxpayer or Authorized Officer
Type or Print Name
Date
DEPT. USE ONLY
VALIDATION
PMD:
Form 04-568 (Rev 02/07)
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