Utah State Tax Commission 210 N 1950 W · SLC, UT 84134 · www.tax.utah.gov
Brine Shrimp Royalty Statement
FEIN / Account Number
Use this number for all references
Start below this line. Enter your company name and address.
Report due on or before
Check box if AMENDED and enter correct ROYALTY PERIOD being amended above.
Gross weight of unprocessed brine shrimp eggs harvested by you during the season. "Gross Weight" means the raw, wet harvested weight of the unprocessed brine shrimp eggs, and includes biomass and refuse harvested with the brine shrimp eggs. Total pounds of all unprocessed brine shrimp eggs harvested during this season by all harvesters. Royalty rate Amount of tax due (line 1 times line 3)
I declare under the penalties provided by law that to the best of my knowledge this is a true and correct report.
_ __________________________________ _ Authorized Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Telephone
Questions may be directed to the Utah State Tax Commission, 210 N 1950 W, SLC, UT 84134-2400; telephone 801-297-3525.
Please separate coupon from return at perforation and return coupon with payment. Keep return with your records. Submit return only if you have an address change.
Brine Shrimp Royalty Statement -- TC-23
Federal ID Number Filing Period Due Date
TC-23.ai Rev. 3/05
Make check or money order payable to the Utah State Tax Commission. Do not send cash. Do not staple check to this coupon.
UTAH STATE TAX COMMISSION BRINE SHRIMP ROYALTY STATEMENT 210 N 1950 W SLC UT 84134-3500
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Brine Shrimp Information
Beginning Feb. 1, 2006, the brine shrimp royalty is 3.75 cents multiplied by the total pounds of unprocessed brine shrimp eggs harvested for that year (Feb. 1, 2006 Jan. 31, 2007). The brine shrimp royalty will continue at that rate until the Legislature makes another rate change.