1. Clear form
Print Form
Utah State Tax Commission
210 N 1950 W • SLC, UT 84134 • www.tax.utah.gov TC-23
Brine Shrimp Royalty Rev. 2/07
Statement
FEIN / Account Number
Use this number for
Start below this line. Enter your company name and address. all references
Royalty Period
Report due on or before
Check box if AMENDED and enter correct
ROYALTY PERIOD being amended above.
1. Gross weight of unprocessed brine shrimp eggs harvested by you during the season.
quot;Gross Weightquot; means the raw, wet harvested weight of the unprocessed brine shrimp 1. lbs.
eggs, and includes biomass and refuse harvested with the brine shrimp eggs.
2. Total pounds of all unprocessed brine shrimp
2.
eggs harvested during this season by all harvesters.
.0375
3. Royalty rate 3.
4. Amount of tax due
00
4.
(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.
Print Form
Brine Shrimp Royalty Statement — TC-23 TC-23.ai Rev. 3/05
Amount
00
Federal ID Number Filing Period Due Date Paid
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
IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form

2. 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.