April
August
Report Period:
& Alaska
& Yakutat
(4 lb can)
(Halves)
(Quarters)
(Talls)
*Thermally Processed Container Size
0405 560 Rev 05/06/13 page 1
10 00
14 74
14 75
14 76
19 99
20 00
63 99
64 00
64 01 or larger
99811 0420Phone 907 465
accompanying
Address
ALASKA
Aleutian Islands
Atka Amlia Islands
belief
Bristol Bay
Check if this is a new address
Chignik
Codes
Company Name
complete
Contact Person
Container Size*
Cook Inlet
declare
DEPARTMENT
Due January 31
Due May 31
Due Sept 30
Email Address
examined
Exported in the round
falsifications
Fax Number
Fresh fillet products
Fresh headed & gutted products
Frozen fillet products
Frozen headed & gutted
Frozen headed & gutted products
including
Indicate Report Period:
January
knowledge
Kodiak
Kuskokwim Yukon Northern
Mail to:
Mailing
Month 1:
Month 2:
Month 3:
Month 4:
Norton Sound Port Clarence
Norton Sound Port Clarence &
OF REVENUETAX DIVISIONPO BOX 110420JUNEAU AK
Page of
penalty
Peninsula
Prince William Sound
Printed or
Product Area
Product Form
Product Form Codes
Production Area
report
salmon chinook
salmon chum
salmon coho
salmon pink
Salmon roe products
salmon sockeye
September December
Signature
Southeastern
Species
Species Codes
State
statements
Telephone Number
Thermally processed products
Title
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Total Value
Total Value
Total Value
Total Value
Typed Name
under
unsworn
USE ONLY
