Form 571 - Alaska Salmon Enhancement Tax Buyer'S Annual Report

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Alaska

571

YEAR

Salmon Enhancement Tax

BUYER’S ANNUAL REPORT

Date Due: March 1

Fisheries Business License Number

EIN

SSN

Taxpayer Name

Telephone Number

Mailing Address

Fax Number

City

State

Zip Code

Check if amended report (attach explanation)

Part 3. Exempt Purchases

Part 1. Region Where Caught

(Required Information - See instructions)

Use this section to report all salmon harvested under

Region

A. Pounds of Salmon

B. Value of Salmon

a special harvest area entry permit issued under AS

1 Southern Southeast

16.43.400.

Example:

Salmon purchased from government

2 Northern Southeast

agencies, salmon hatcheries or a fishing derby.

3 Prince William Sound

Pounds of Salmon

Value of Salmon

4 Cook Inlet

5 Kodiak

2 $

6 Chignik

7 Yakutat

8 Outside

9 Bonus (additional value)

10 TOTAL (add lines 1-9)

Part 2. Salmon Enhancement Tax - Region Where Purchased

Region

A. Pounds of Salmon

B. Value of Salmon

11 Southern Southeast

12 Northern Southeast

13 Prince William Sound

14 Cook Inlet

15 Kodiak

16 Chignik

17 Yakutat

18 Outside

19 Bonus (additional value)

20 TOTAL (add lines 11-19)*

* Totals on line 10, columns A and B must equal totals on line 20, columns A and B

WHO MUST FILE THE BUYER’S ANNUAL REPORT?

Each licensed buyer that purchases or otherwise acquires salmon in a regional aquacultural association or in a location where a salmon enhancement tax

has been enacted must file this report. This report is to account for all salmon purchased or acquired during this tax year. The totals from Part 1 and Part

2 column B should equal the sum totals reported during the tax year.

I declare under penalty of unsworn falsification that this report, including all accompanying schedules and statements, has been examined by

me and to the best of my knowledge and belief is true, correct and complete.

Signature

Printed Name

Title

Date

DEPT USE ONLY

VALIDATION

PMD:

571

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