Form 0405-578 - Seafood Marketing Assessment Annual Return - 2013

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578:09 27 13

Alaska

578

2013 Seafood Marketing Assessment

DEPARTMENT USE ONLY

ENV

Annual Return

FSN

Due April 1, 2014

Taxpayer Name

EIN

SSN

Check one:

Original

Amended

Bonus: Indicate below the month and year bonus payments were made.

Month:_____________Year:____________

(attach explanation)

C. Value of Seafood Products

A. Fish. Bus. Lic. #

B. Facility Location or Vessel Name

(Line 6, parts I & II, page 2 from

each fisheries tax return)

Total value of seafood products listed in column C. If less than $50,000, you are not required to file this form.

Stop here if less than $50,000.

Assessment. Multiply the value on line 1 by .5% (.005). This is your Seafood Marketing Assessment.

$0.00

Amended and bonus returns

Tax payments made with original and previously filed bonus/amended returns.

Amount (Refund) due. Subtract line 3 from line 2.

Note: If your combined liabilities exceed $150,000 you must pay online using the Online Tax Information System (OTIS) at or by wire transfer.

OTIS (confirmation#________________________)

Wire transfer (date _________________)

Check if you are paying by

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.

Taxpayer/Officer/Member Signature

Printed Name

Date

Department use only PMD

Validation

Pay online at or make check payable to State of Alaska

578

Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420

0405-578 Rev 09/27/13