Form 681 CDQ Credit Application  Fill In
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Yes No If Yes indicate the percentage owned % You must attach the following documents and information before this application may be approved (failure to file a timely and complete * All contributions must be fisheries related 6816810405 681 Rev 03/13 A copy of the current harvest/royalty agreement between you and the CDQ holder A receipt from the nonprofit corporation verifying the date and amount of the contribution Note: only cash contributions made as A statement from the nonprofit corporation specifying how the contribution will be used and an agreement by the nonprofit A statement from you that the contribution to the nonprofit entity was expressly conditioned upon its use exclusively for the Alaska Amount application as required by AS 43 77 040 constitutes a waiver of the credit) CDQ Credit Application community development quota (CDQ) credit corporation to allow the Tax Division to audit all of its accounts relating to the contribution DateSignaturePrint nameDateDepartment use only: Approved DisapprovedDepartment signatureTitlePrinted nameMail to: Alaska Department of Revenue PO Box 110420 Juneau AK 99811 0420 Does the nonprofit corporation that received your contribution have a direct or indirect ownership interest in your company? Does your company have a direct or indirect ownership interest in the nonprofit corporation that received your contribution? donations qualify for the credit Due January 31 of the year following the year of contribution Facilities grants Facilities loans Fishery Resource Landing Tax Have you or a related person received a loan or grant from any nonprofit corporation to whom you made a contribution? Yes No Intended use of the contribution* Name of Non Profit Corporation Receiving the Contribution (recipient) of criteria that qualify contributions for a Phone Number purposes indicated above as authorized by AS 43 77 040 Recipient Address Refer to AS 43 77 040 for further definition Research grants Scholarships Seafood industry training SSNYear of ContributionPhone NumberTaxpayer NameFax NumberMailing AddressEmailCityStateZip CodeContact Person The fishery resources by unprocessed weight and species harvested under CDQ Total contributions Transportation facilities grants Transportation facilities loans