Form NOAA 34-82 NOAA 34-82 Capital Construction Fund Deposit and Withdrawal Report

PRIVACY ACT STATEMENT
Authority: The collection of this information is authorized by Title 45
U.S.C 1177 and 50 CFR Part 259. The data will primarily be used for the
evaluation of eligibility in connection with application to establish a
Capital Construction Fund Account. Establishment of the account will not be
considered unless all requested information is furnished.
Purpose: In order to determine qualification for, and to administer, the
Capital Construction Fund, the NOAA National Marine Fisheries Service (NMFS)
requires financial information, vessel owner contact information, date of
birth, Tax Identifying Number and vessel descriptive information.
Routine Uses: The Department will use this information to determine
qualification for a Capital Construction Fund Agreement. Disclosure of this
information is permitted under the Privacy Act of 1974 (5 U.S.C. Section
552a), to be shared within the Financial Services Division, in order to
coordinate monitoring of the Agreements. Disclosure of this information is
also subject to all of the published routine uses as identified in
Commerce/NOAA-21, Financial Services Division.
Disclosure: Furnishing this information is voluntary; however, failure to
provide complete and accurate information will prevent the determination of
qualification for the program, and continued participation.

NOAA FORM 34-82
OMB NO 0648-0041
Expires: 3/31/2019
Mail report and tax return copy to:
NOAA Fisheries F/MB5
Capital ConstructionFund Program
1315 East-West Highway
Silver Spring, MD 20910-3282
301-713-2393
301-427-8728

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NOAA Fisheries

Prepare a separate Form 34-82 report for each account you maintain.
DEPOSITORY BANK, OR INVESTMENT FIRM

Capital Construction Fund Program
DEPOSIT/WITHDRAWAL REPORT

Name:

AGREEMENT HOLDER:

CCF CASE NUMBER

Name :

CCF -

-

Address:
City and State :

Due 30 days after filing date of Federal Tax Return (including
extensions). This report must be filed annually, whether or not
agreement activity took place. Attach a signed copy of the
Federal Income Tax Return, as filed with the IRS, to this report.

Number :

Savings

Type of Investment Account:

Did you reduce taxable income for the current tax year due to CCF activity?

Money Market

Checklng

/
Telephone No:

Other : (describe)

YES

NO

CLASSIFICATION OF DEPOSITS:

Amount deferred $

Was a CCF deposit made during the current year for taxes deferred in the prior year?
Clearly identify this deposit in Account Activity section.

REPORT OF DEPOSITORY
ACTIVITY FOR TAX YEAR ENDED

Date Opened:

YES

ORDINARY INCOME
(tax deferred)

NO

WITHDRAWAL

DEPOSIT

Notes :

CAPITAL
(funds not tax deferred )

CAPITAL GAIN
(tax deferred)
DEPOSIT

WITHDRAWAL

SUMMARY
BALANCE

WITHDRAWAL

DEPOSIT

BALANCE FORWARD - FROM PRIOR YEAR'S REPORT
(Should be same as last year's "Balance - End of Year" amount.
If different, attach a reconciling schedule.)
ACCOUNT ACTIVITY FOR THE TAX YEAR
Summarize interest and dividend deposits. For deposits of vessel income, provide name of
vessel and Schedule A page number. For all withdrawals, provide name of vessel and
Schedule B page number for project.
DATE

DESCRIBE

SCH. A
OR
SCH. B
PAGE #

1

1

2

2

3

3

4

4

5

5

6

6

7

7

8

8

9

9

10

10

TOTAL EACH COLUMN (incIude "Balance Forward" amount for each column)
WITHDRAWALS FOR THE YEAR (copy totals from adjacent column)

(
(

)

(

)
)

(

(

)
(

)

)

BALANCE - END OF TAX YEAR (net amounts and Summary Balance)

Public reporting burden for this collection of information is estimated
to average 20 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the colleciton of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, to NOAA Fisheries, F/MB5, 1315 East-West Hwy.,
Silver Spring, MD 20910.

NOAA FORM 34-82 CCF - DEPOSIT/WITHDRAWAL REPORT

I certify that for this tax year, there were no withdrawals or transfers other than those enumerated above for this Capital Construction Fund agreement. This report reflects true and complete
statements in accordance with all applicable rules and regulations issued or adopted by the Secretary of Commerce pertaining to Section 607 of the Merchant Marine Act of 1936, as amended.
Information on this report is complete,true and correct to the best of my knowledge and belief. (Following Information is required.)
SIGNATURE
representatlve

DATE

Agreement holder or officer

Authorized

/