Form 04-681 - Fishery Resource Landing Tax Cdq Credit Application - 1998
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1State of Alaska
Alaska Department of Revenue
Income and Excise Audit Division
1998 Fishery Resource Landing Tax
PO Box 110420
Juneau, AK 99811-0420
CDQ Credit Application
Telephone (907) 465-3775
Fax (907) 465-2375
Due Date: January 31, 1999
Federal EIN or SSN
Fisheries Business License Number (if applicable)
Individual or Corporate Name
Telephone Number
Business Name
Fax Number
Mailing Address
E-mail Address
City
State
Zip Code
Contact Person
Date of Contribution
Name of Nonprofit Corporation Receiving the Contribution (Recipient)
Recipient Address
Recipient Telephone Number
Intended use of the contribution*
Amount
Scholarships
* All contributions must be
Industry training
fisheries related. Refer to
Transportation grants
AS 43.77.040 for further
Transportation loans
definition of criteria which
Facilities grants
qualify contributions for a
Facilities loans
CDQ credit.
Research grants
Total contributions
You must attach the following documents and information before this application can 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 for the amount of the contribution. (Note that 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 department to audit all of its accounts relating to the contribution;
3.
Documentation regarding the authority of the person to harvest under a community development quota; and
4.
The fishery resources, by unprocessed weight and species, harvested under the community development quota; and
5.
A statement that the contribution to the nonprofit entity was expressly conditioned upon its use exclusively for one or more of
the purposes authorized by AS 43.77.040.
Have you or a related person received a loan or grant from any nonprofit corporation to whom you made a contribution?
Yes
No
Signature of Applicant
Type or Print Name
Date
DEPARTMENT USE ONLY
BY: (Signature)
Date
Approved
Disapproved
Form 04-681 (Revised 11/98)
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