(4 lb can)
(Halves)
(Quarters)
(Talls)
*Thermally Processed Container Size Codes
0405 561 Rev 12/29/14 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
accompanying
Address
Alaska
ALASKA
Aleutian Islands Atka Amila Islands & Alaska Peninsula
Annual Salmon Production Report
Area B:
Area C:
Area D:
Area E:
Area F:
Area G:
Area H:
Area I: Exported in the round
belief
Bristol Bay
Check if this is a new address
Chignik
Company Name
complete
Contact Person
Container Size*
Cook Inlet
declare
DEPARTMENT
DEPARTMENT
Due January 31 2015
Email Address
examined
falsifications
Fax Number
Fresh fillet products
Fresh headed & gutted products
Frozen fillet products
Frozen headed & gutted products
including
January 1 December 31 2014
knowledge
Kodiak
Kuskokwim Yukon Northern Norton Sound Port Clarence & Kotzebue
Mail to:
Mailing
OF REVENUETAX DIVISIONPO BOX 110420JUNEAU AK
Page of
penalty
Prince William Sound
Printed or
Product Form
Product Form Codes
Production
Production
Production
Production
Production
Production
Production
Production
Production
report
REPORT
REPORT PERIOD:
salmon chinook
salmon chum
salmon coho
salmon pink
Salmon roe products
salmon sockeye
Signature
Southeastern & Yakutat
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)
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Tot Net Wt (lbs)
Typed Name
under
unsworn
USE ONLY
Zip Code
