Form 571 Buyers Annual Report Form Fill In
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Check if amended report (attach explanation) * Totals on line 10 columns A and B must equal totals on line 20 columns A and B 0405 571 Rev 02/06/14 1 Southern Southeast 10 TOTAL (add lines 1 9) 11 Southern Southeast 12 Northern Southeast 13 Prince William Sound 14 Cook Inlet 15 Kodiak 16 43 400 16 Chignik 17 Yakutat 18 Outside 19 Bonus (additional value) 2 column B should equal the sum totals reported during the tax year 2 Northern Southeast 20 TOTAL (add lines 11 19)* 3 Prince William Sound 4 Cook Inlet 5 Kodiak 571571Mail to: Alaska Department of Revenue PO Box 110420 Juneau AK 99811 0420 6 Chignik 7 Yakutat 8 Outside 9 Bonus (additional value) A Pounds of Salmon a special harvest area entry permit issued under AS agencies salmon hatcheries or a fishing derby Alaska B Value of Salmon BUYER S ANNUAL REPORT Date Due: March 1 DEPT USE ONLY Each licensed buyer that purchases or otherwise acquires salmon in a regional aquacultural association or in a location where a salmon enhancement tax Example: Salmon purchased from government Fax Number Fisheries Business License Number 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 I declare under penalty of unsworn falsification that this report including all accompanying schedules and statements has been examined by Mailing Address me and to the best of my knowledge and belief is true correct and complete Part 1 Region Where Caught (Required Information See instructions) Part 2 Salmon Enhancement Tax Region Where Purchased Part 3 Exempt Purchases Pounds of Salmon Printed Name Region Salmon Enhancement Tax Signature State Taxpayer Name Telephone Number Title Use this section to report all salmon harvested under VALIDATION Value of Salmon WHO MUST FILE THE BUYER S ANNUAL REPORT? Zip Code