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Form 04-680.nov - Alaska Fishery Resource Landing Tax Request For Notice Of Value - 2003

Department of Revenue

2003 Alaska Fishery Resource Landing Tax

Tax Division

PO Box 110420

Request for Notice of Value

Juneau, AK 99811-0420

Telephone 907.465.3775

Form 04-680.NOV

Fax 907.465.2375

This form is available online at

Due: January 31, 2004

Federal EIN or SSN

Fisheries Business License Number (If Applicable)

Individual or Corporation Name

Telephone Number

Business Name

Fax Number

Mailing Address

E-mail Address

City

State

Zip Code

Contact Person

In order to receive an extension to file your 2003 Fishery Resource Landing Tax, this Notice of Value must be filed by

January 31, 2004.

Note: The extension to file is not an extension to pay. Full payment of your Fishery Resource Landing Tax Liability

is due by March 31, 2004.

We hereby notify the Alaska Department of Revenue that we are required to file a 2003 Fishery Resource Landing Tax return for

fishery resources landed in Alaska during 2003. We request that the Department of Revenue provide Notice of Value for each species

listed below. (Note that the species value as provided by the Department of Revenue must be used to file the fishery resource landing

tax return).

Species

Species Code

Attach a separate schedule if more species were landed in 2003.

Signature of Applicant

Type or Print Name

Date

Form 04-680.NOV (Rev 03/04)Webform

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Form 04-680.nov - Alaska Fishery Resource Landing Tax Request For Notice Of Value - 2003