Form 681 - Alaska Fishery Resource Landing Tax Cdq Credit Application
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1Alaska
681
Fishery Resource Landing Tax
CDQ Credit Application
Due January 31 of the year following the year of contribution
Year of Contribution Phone Number
EIN
SSN
Taxpayer Name
Fax Number
Mailing Address
Email
City
State
Zip Code
Contact Person
Name of Non-Profit Corporation Receiving the Contribution (recipient)
Recipient Address
Phone Number
Intended use of the contribution*
Amount
* All contributions must be fisheries related.
Scholarships
Refer to AS 43.77.040 for further definition
of criteria that qualify contributions for a
Seafood industry training
community development quota (CDQ) credit.
Transportation facilities grants
Transportation facilities loans
Facilities grants
Facilities loans
Research grants
Total contributions
Have you or a related person received a loan or grant from any nonprofit corporation to whom you made a contribution?
Yes
No
Does your company have a direct or indirect ownership interest in the nonprofit corporation that received your contribution?
Yes
No
If Yes, indicate the percentage owned __________%
Does the nonprofit corporation that received your contribution have a direct or indirect ownership interest in your company?
Yes
No
If Yes, indicate the percentage owned __________%
You must attach the following documents and information before this application may 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 verifying the date and amount of the contribution. Note: 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 Tax Division to audit all of its accounts relating to the contribution.
3
The fishery resources, by unprocessed weight and species, harvested under CDQ.
4
A statement from you that the contribution to the nonprofit entity was expressly conditioned upon its use exclusively for the
purposes indicated above as authorized by AS 43.77.040.
5
A copy of the current harvest/royalty agreement between you and the CDQ holder.
Date
Signature
Print name
Department use only: Approved
Disapproved
Department signature
Date
Printed name
Title
681
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-681 Rev 03/13
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