Certificate of Construction or Reconstruction

OMB Control No. 0648-0041

Expiration Date: 3/31/2016

Case No. CCF-

CERTIFICATE OF CONSTRUCTION/RECONSTRUCTION

The undersigned hereby certifies that:

( ) Construction ( ) Reconstruction*

of Schedule B, page , , was completed

(Name of Vessel)

on , by ( ) Contract ( ) Owner ( ) Both,

(Date)

for a TOTAL COST of $ . .

If available, show breakdown below for above Total Cost:

Hull & House $

Machinery $

Electronics $

Fixed Gear $

Other $

(Signature)

(Print Name)

(Date)

*NOTE: All, or the major portion (ordinarily, not less than 80 percent), of the total cost must (for the purpose of meeting the minimum cost requirement) be classifiable as a capital expenditure for IRS purposes. That portion of cost not classifiable as a capital expenditure is not eligible for payment through the CCF.

--50 CFR, sec 259.31(b)(2)

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other suggestions for reducing this burden to NOAA Fisheries, F/MB5, 1315 East West Hwy., Silver Spring, MD 20910.

The information collected is confidential under the Magnuson-Stevens Fishery Conservation and Management Act, as amended in 2006, NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics and 15CFR259.38(b).

Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subjected to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.