Reset
Print
DEPARTMENT USE ONLY
Alaska
ENV
582
FSN
2014 Regional Seafood Development Tax Return
Fisheries Business License #
Phone Number
Fax Number
EIN
SSN
Taxpayer Name
Facility Location
or Vessel Name
Mailing Address
City
State
Zip Code
Check One
Month/year resource purchased
Note different due dates
Month:
Year:
Buyer
Monthly tax - due last day of month following month of purchase
Year resource exported/sold
Yearly tax - due March 31, 2015
Fisherman
2014
Type of Return
(Check one)
Month/year resource originally purchased
Month/year bonus payment made
Original
Bonus
Amended*
Month:
Year:
Month:
Year:
* Attach explanation
Tax Calculation
A.
B.
C.
Region
Fishery
Pounds
Tax (Column A x B)
Value
Rate
1
Bristol Bay
Salmon drift gillnet - S03T
1% (.01)
1. $
2
Prince William Sound
Salmon drift gillnet - S03E
1% (.01)
2. $
3
Prince William Sound
Salmon set gillnet - S04E
1% (.01)
3. $
4
Total (add lines 1 through 3, Column C)
4. $
AMENDED AND BONUS RETURNS ONLY Taxes previously paid for this month/year
5
5. (
)
6
TOTAL TAX LIABILITY (REFUND) DUE (Subtract line 5 from line 4)
6. $
Electronic Payment Information
Note: If your liability is $100,000 or more, you must use the Online Tax Information System (OTIS) at or wire transfer.
Check if you are paying by:
OTIS 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
Date
Printed Name
Printed Title
Department use only PMD
Validation
Pay online at or make check payable to State of Alaska
582
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-582 Rev 09/30/13