Form 578 Fillable Alaska Seafood Marketing Assessment Form
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Amended Bonus: Indicate below the month and year bonus payments were made (attach explanation) (Line 6 parts I & II page 2 from 0405 578 Rev 01/01/15 A Fish Bus Lic # Amended and bonus returns Amount (Refund) due Subtract line 3 from line 2 and belief is true correct and complete Annual Return Assessment Multiply the value on line 1 by 5% ( 005) This is your Seafood Marketing Assessment B Facility Location or Vessel Name by wire transfer C Value of Seafood Products Check if you are paying by OTIS (confirmation# ) Wire transfer (date ) Check one: Original DEPARTMENT USE ONLY Due April 1 2015 each fisheries tax return) Form 578 I declare under penalty of unsworn falsification that the information provided in this return has been reviewed by me and to the best of my knowledge Month: Year: Note: If your combined liability is $150 000 or more you must pay using the Online Tax Information System (OTIS) at www tax alaska gov or Pay online at www tax alaska gov or make check payable to State of AlaskaMail to: Alaska Department of Revenue PO Box 110420 Juneau AK 99811 0420 Seafood Marketing Assessment Stop here if less than $50 000 Tax payments made with original and previously filed bonus/amended returns Taxpayer Name Taxpayer/Officer/Member SignaturePrinted NameDateDepartment use only PMDValidation Total value of seafood products listed in column C If less than $50 000 you are not required to file this form