ACE-2 Annual Capital Expenditures Survey

U.S. DEPARTMENT OF COMMERCE YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code,

ACE-2

FORM
(01-28-2011) Draft 2

Economics and Statistics Administration

U.S. CENSUS BUREAU

2010 ANNUAL CAPITAL
EXPENDITURES SURVEY

requires businesses and other organizations that receive this questionnaire to
answer the questions and return the report to the U.S. Census Bureau. By the
same law, YOUR REPORT IS CONFIDENTIAL. It may be seen only by
persons sworn to uphold the confidentiality of Census Bureau information
and may be used only for statistical purposes. Further, copies retained in
respondents’ files are immune from legal process.

This questionnaire collects
capital expenditures
information from nonfarm
businesses including but not
limited to:
• Small employer companies
• Self employed persons
• Independent salespersons
(e.g., cosmetic
representatives)
• Independent commission
workers (e.g., real estate
and life insurance
salespersons)
• Independent contractors
(truckers, private duty
nurses, construction
contractors)
• Doctors, lawyers, investors,
accountants

Even if this questionnaire
was mailed to your home
address and the business is
not located at this address,
the form is applicable and
must be completed.

(Please correct any errors in name, address, and ZIP Code.)
Respondents are not required to respond to any information collection unless it displays a valid approval
number from the Office of Management and Budget. This 8-digit number appears at the top of this page.

Electronic Reporting
To complete this survey online go to: http://bhs.econ.census.gov/BHS/acesict/index.html
Click on "Centurion" and use your Username and Password to login.

Username:
Password:

PLEASE REFER TO THE ENCLOSED INSTRUCTIONS AND DEFINITIONS PAGE
BEFORE COMPLETING THIS SURVEY.
Report the following capital expenditures data for the entire business. Report dollar values
rounded to thousands. Exclude land.
Report capital expenditures your business made during the 2010 reporting period. If your
Capital Expenditures
business did not make any capital expenditures enter "0" on the appropriate line(s).

ITEM 1

for 2010

Dol.

3 000

Mil.

a. Total Capital Expenditures
(The sum of lines b, c, d, and e should equal the value reported in line a.)

224

b. New Structures (Include major additions, alterations, and capitalized
repairs to existing structures)

201

Thou.

Dol.

211

c. Used Structures

18040014

§3%!/¤

Example: If figure
is $2,600.00 report

Mil. Thou.

202

d. New Equipment
212

e. Used Equipment

ITEM 2

Capital Lease
Arrangements
for 2010

Report the following capital lease data for the entire business.
Report in thousands of dollars.

Report the estimated cost of assets acquired under capital lease arrangements entered into
during the year. Exclude the value of structures and equipment which you rent and periodic
payments made for leased structures and equipment. (For additional information see Item 2
on page 2 of the Instructions and Definitions sheet.)

USCENSUSBUREAU

Mil.

Thou.

Dol.

411

Page 1

REPORTING PERIOD COVERED
a. Do the reported data cover the calendar year 2010?
FROM

95
1

YES

2

NO – Specify period covered

Month

➤

Day

TO
Year

Month

Day

Year

Month

Day

Year

Month

Day

Year

4

3

OWNERSHIP INFORMATION
a. Was this business in operation on December 31, 2010?
96
1

YES

2

NO – Give date operations ceased

➤

3

b. Did the ownership of this business change during the
year ending December 31, 2010?
97

YES – Specify date of change
AND fill in c. below

2

NO

➤

3

➤

1

c. Name of new operator/business

Contact name at new company

Number and street address

Contact area code & phone number

City

State

ZIP Code

BRIEFLY DESCRIBE THE CAPITAL EXPENDITURES

Federal Employer Identification Number – If applicable, please list the EIN of the
business you are reporting for in the box provided

EIN

§3%!7¤

Name of person to contact regarding this report (Please print or type)

Printed name of person completing this report

Telephone
number

Telephone
number

Area code

Number

Area code

Number

E-mail address

Month

Day

Year

Date

Please be sure to correct any name, address, and ZIP Code errors to the imprinted address on the front of this survey form.

PLEASE RETURN YOUR
COMPLETED FORM TO

FORM ACE-2

U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

OR

FAX the form to
1–800–438–8040

Page 2

18040022

CERTIFICATION – This report is substantially accurate and has been prepared in accordance with instructions.