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9/52 2%30/.3% )3 2%15)2%$ "9 ,!7 4ITLE 5NITED 3TATES #ODE 53# 3ECTIONS
AND AUTHORIZES THIS COLLECTION 3ECTIONS AND REQUIRE YOUR RESPONSE 4HE 53 #ENSUS
"UREAU IS REQUIRED BY 3ECTION OF THE SAME LAW TO KEEP YOUR INFORMATION #/.&)$%.4)!, AND
CAN USE YOUR RESPONSES ONLY TO PRODUCE STATISTICS 4HE #ENSUS "UREAU IS NOT PERMITTED TO PUBLICLY
RELEASE YOUR RESPONSES IN A WAY THAT COULD IDENTIFY YOUR BUSINESS ORGANIZATION OR INSTITUTION 0ER
THE &EDERAL #YBERSECURITY %NHANCEMENT !CT OF YOUR DATA ARE PROTECTED FROM CYBERSECURITY
RISKS THROUGH SCREENING OF THE SYSTEMS THAT TRANSMIT YOUR DATA
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4HIS SURVEY COLLECTS CAPITAL
EXPENDITURES INFORMATION
FROM NONFARM BUSINESSES
INCLUDING BUT NOT LIMITED TO
• 3MALL EMPLOYER COMPANIES
• 3ELF EMPLOYED PERSONS
EG DOCTORS LAWYERS
INVESTORS ACCOUNTANTS
• )NDEPENDENT SALES PERSONS
EG COSMETIC
REPRESENTATIVES
• )NDEPENDENT COMMISSION
WORKERS EG REAL ESTATE
AND LIFE INSURANCE
SALESPERSONS
• )NDEPENDENT CONTRACTORS
TRUCKERS PRIVATE DUTY
NURSES CONSTRUCTION
CONTRACTORS
%VEN IF THIS SURVEY REQUEST
WAS MAILED TO YOUR HOME
ADDRESS AND THE BUSINESS IS
NOT LOCATED AT THIS ADDRESS
THE FORM IS APPLICABLE AND
MUST BE COMPLETED
PLEASE REFER TO THE INSTRUCTIONS AND DEFINITIONS PAGE BEFORE
COMPLETING THIS SURVEY.
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2EPORT DOLLAR VALUES ROUNDED TO THOUSANDS %NTER IN THE THOUSANDS COLUMN IF EXPENDITURES ARE LESS THAN ONE
THOUSAND AFTER ROUNDING If your business did not make any capital expenditures during 20report "0"
on APPLICABLE LINE
Example: If figure
is $600.00 report
-IL 4HOU
Example: If figure
is $ .00 report
-IL 4HOU
#APITAL
%XPENDITURES
for 20
-IL
4HOU
a. 4OTAL #APITAL %XPENDITURES 4HE SUM OF LINES B C D AND E SHOULD EQUAL THE VALUE REPORTED IN LINE A
b. .EW 3TRUCTURES )NCLUDE MAJOR ADDITIONS ALTERATIONS AND CAPITALIZED REPAIRS TO EXISTING STRUCTURES
c. 5SED 3TRUCTURES
d. .EW %QUIPMENT
e. 5SED %QUIPMENT
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#APITAL ,EASE
!RRANGEMENTS
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Exclude periodic payments under capital and operating leases or any rental agreement. (For additional
JOGPSNBUJPOTFF*UFNPOQBHFPGUIF*OTUSVDUJPOTBOE%FGJOJUJPOT TIFFU
0AGE
REPORTING PERIOD COVERED
B %PUIFSFQPSUFEEBUBDPWFSUIFDBMFOEBSZFBS
&2/9%3
-ONTH
$AY
4/
9EAR
-ONTH
$AY
9EAR
-ONTH
$AY
9EAR
-ONTH
$AY
9EAR
➤
./ n 3PECIFY PERIOD COVERED
a. Was this business in operation on December 31, 20?
9%3
➤
./ n 'IVE DATE OPERATIONS CEASED
b. Did the ownership of this business change during the
year ending December 31, 20?
➤
9%3 n 3PECIFY DATE OF CHANGE
!.$ FILL IN C BELOW
➤
./
c. .AME OF NEW OPERATORBUSINESS
.UMBER AND STREET ADDRESS
#ONTACT NAME AT NEW COMPANY
#ITY
#ONTACT AREA CODE PHONE NUMBER
3TATE
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OWNERSHIP INFORMATION
:)0 #ODE
REMARKS – BRIEFLY DESCRIBE THE CAPITAL EXPENDITURES 2%0/24%$ ). )4%-
QUESTION RELATED TO THE CORONAVIRUS PANDEMIC - The following question is focused on helping the
U.S. Census Bureau measure business access to and use of financial assistance, and the impact on capital expenditure
investments during the Coronavirus pandemic.
In 2020, did this business request and/or receive financial assistance related to the Coronavirus
pandemic from any of the following sources?
Select all that apply for each column.
Requested
Received
Paycheck Protection Program (PPP)
Economic Injury Disaster Loans (EIDL)
Small Business Administration (SBA) Loan Forgiveness
Main Street Lending Program
Pandemic Unemployment Assistance (PUA)
All other sources (tax credits, other government programs,
banks, owners, family and friends, etc.)
No, this business did not request or receive any financial assistance in 2020 related to the Coronavirus pandemic.
7ORKSHEET !#%
0AGE
Federal Employer Identification Number – If applicable, please provide the EIN
of the business you are reporting for.
EIN
)PVST
.JOVUFT
➤
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CERTIFICATION – This report is substantially accurate and has been prepared in accordance with instructions.
Name of person to contact regarding this report
Printed name of person completing this report
Telephone
number
Telephone
number
Area code
Number
Area code
Number
E-mail address
Month
Day
Year
Date
For more information, refer to: portal.census.gov or call 1-800-528-3049
4(!.+ 9/5 &/2 9/52 #//0%2!4)/. !.$ !33)34!.#% ). 4()3 3526%9
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Page 3
| File Type | application/pdf |
| File Title | ACE-2_120920.pdf |
| Author | aiken303 |
| File Modified | 2021-02-04 |
| File Created | 2020-12-09 |