Form 0405-580 - Dive Fishery Management Assessment - 2008
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State of Alaska
580
Department use only
Envelope #
Department of Revenue
FSN
SEQ #
Dive Fishery Management Assessment
Federal ID
EIN
SSN
Fisheries Business License
Name of Buyer/Permit Holder
Buyer Facility Location or Vessel Name
Business Name
Telephone Number
Mailing Address
Fax Number
City
State
Zip Code
Email Address
Check one:
Check if this is an Amended Return
Fisherman
Licensed Buyer
Monthly Pay & Report Filer
(attach explanation)
Fisherman: Indicate the year the resource was exported from the state or sold to an unlicensed buyer
Year:____________
Due Date is March 31 of the following year
Licensed buyer
Year: ___________
Monthly Pay & Report Filer
Year: ___________
Quarter in which dive resources were purchased from fishermen
Month in which dive resources were purchased or exported
Quarter
Due Date
Month
Due Date
Month
Due Date
Month
Due Date
Jan
Feb 15
May
Jun 15
Sep
Oct 15
Jan - Mar
April 30
Feb
Mar 15
Jun
Jul 15
Oct
Nov 15
Apr - Jun
July 31
Jul - Sep
Mar
Apr 15
Jul
Aug 15
Nov
Dec 15
October 31
Apr
May 15
Aug
Sep 15
Dec
Jan 15
Oct - Dec
January 31
Check if this is a Bonus Return
Check if this is a Bonus Return
Above indicate the year and quarter the resource was originally
Above indicate the year and month the resource was originally
reported. Below indicate the year and quarter of the resource
reported. Below indicate the year and month of the bonus
bonus payment(s).
payment(s).
Quarter: _______________ Year: ____________
Month: _______________ Year: ____________
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)
4
Total (add lines 1 through 3, Column D)
$
5
AMENDED AND BONUS RETURNS ONLY Taxes previously paid this month/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 Tax Online Payment System (TOPS) at or wire transfer.
Check if you are remitting by:
TOPS 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 a true, correct, and complete return.
Signature
Print name and title
Date
Pay online at
Mail to: Alaska Department of Revenue - Tax Division
or make check payable to State of Alaska
PO Box 110420 • Juneau, AK 99811-0420
Telephone 907-465-2320
Department use only PMD
FAX 907-465-3566
Validation
580
Form 0405-580 rev 05/08 • page 1
Retain a copy for your records
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