The Alaska Form 11 525 is a tax form used to report income and deductions for individual taxpayers in the state of Alaska. This form must be completed and filed by all Alaskan taxpayers who have earned income or incurred deductions during the taxable year. The deadline for filing this form is typically April 15th, although it may be extended if the taxpayer files for an extension. In order to complete the Alaska Form 11 525, you will need to gather information about your income and deductions from throughout the year. You will then need to enter this information into the appropriate sections of the form. Be sure to review the instructions carefully before completing your return, as there are specific requirements that must be met in order to claim certain deductions. If you
| Question | Answer |
|---|---|
| Form Name | Alaska Form 11 525 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dfg, licensee, Issuance, Nonresident |
Department of Fish and Game
Division of Administrative Services
Licensing Section
P.O. Box 115525
Juneau, Alaska
Phone: (907)
COMMERCIAL FISHING CREWMEMBER LICENSE APPLICATION
License Number Issued:_____________________
If you are not in substantial compliance with your child support order and are on Alaska's Child Support Services Division's (CSSD) outstanding report, your license is null and void at the time of purchase. You will be subject to criminal sanctions for participation in any commercial crewmember activities. The Department of Fish and Game will match each licensee against CSSD's report. Notice will be served that the license is void and invalid.
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CHECK ONLY ONE: (License Type / Class) |
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CHECK AND COMPLETE THE FOLLOWING AS |
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Resident |
/ Class 30 |
$60.00 |
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Nonresident / Class 31 |
$200.00 |
THEY APPLY TO APPLICANT: |
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Resident Child / Class 34 (10 or less years old) $5.00 |
Nonresident Child / Class 35 |
$145.00 |
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Alaska Resident |
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Residency: Actual number |
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Resident 7 day / Class 36 $30.00 |
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Nonresident 7 day /Class 37 |
$30.00 |
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of years and months as a |
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*Duplicate / Class 32 |
$5.00 |
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Nonresident |
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resident is required. If non- |
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For class 36, and 37 |
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AM |
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resident, write "none." |
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Years |
Months |
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STARTING DATE |
M M / D D / Y Y Y Y |
STARTING HOUR |
PM |
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U.S. Citizen |
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This certiies that application is being made in accordance with applicable laws. |
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License Year |
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Alien |
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Name (irst) |
(middle) |
(last) |
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Alien Reg. No. |
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Mailing Address |
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Physical Location of Residence (If same as Mailing address, write "Same." |
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City, State, |
Zip Code |
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Country |
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City, State, Zip Code |
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Social Security Number (required) |
Weight (lbs) |
Eye Color Hair Color |
Height (FT/IN) |
Sex |
Drivers License No. |
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M F
Birth Date
mm/dd/yy
Telephone Number
(Optional)
Fax Number
Your
Social Security Number Advisory: You are required to provide your social security number, if over 16 years of age, when applying for a Commercial Crewmember license unless you have an alien registration number. This information is required per AS 25.27.244.
ALASKA RESIDENT AS 16.05.415 & AS 16.05.940: “resident” means, 1) a person (including an alien) who is physically present in Alaska with the intent to remain indeinitely and make a home here, has maintained that person’s domicile in Alaska for the 12 consecutive months immediately preceding this application for a license, and is not claiming residency or obtaining beneits under a claim of residency in another state, territory or country; 2) a member of the military service or U.S. Coast Guard who has been stationed in Alaska for the 12 consecutive months immediately preceding this application for a license; or 3) a dependent of a resident member of the military service or U.S. Coast Guard who has lived in Alaska for the 12 months immediately preced- ing this application for a license. A person who does not otherwise qualify as a resident may not qualify by virtue of an interest in an Alaska business. A person who establishes residency as outlined above remains a resident during an absence for from the state unless during the absence the person (1) establishes or claims residency in another state, territory, or country; or (2) performs an act, or is absent under circumstances, that are inconsistent with the intent to remain indeinitely and make a home in Alaska. A person who establishes residency as outlined above remains a resident during an absence from the state unless during the absence the person (1) establishes or claims residency in another state, territory or country; or (2) performs an act or is absent under circumstances that are inconsistent with the intent to remain indeinitely and make a home in Alaska.
AS 16.05.480(a) A person engaged in commercial ishing is required to hold a limited entry permit, an
Payment Information (Make checks payable to State of Alaska)
Check or Money Order |
Visa |
MasterCard |
Card No. |
Expire
Signature _________________________________________________
AFFIDAVIT FOR DUPLICATE COMMERCIAL FISHING CREWMEMBER LICENSE
I hereby report the loss of my current Commercial Fishing Crewmember License issued to me in accordance with the Fish and Game Code of Alaska as follows:
Number of License, If Known |
Issued By (Name of License Oficer) |
Date of Issuance
Place of Issuance
I have personally reviewed the information on this application and I hereby certify that all the information on this applica- tion is true and correct and that I understand this information except social security number is subject to public disclosure. NOTE: Providing false information is subject to a maximum ine of $10,000 or one year imprisonment or both, per AS
11.56.210 and AS 16.05.665.
Applicant X
Date: