MC-33402 (2002 Version)

Form MC-33402

Page 8

16 DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES
General - The materials, parts, and supplies listed below are those commonly consumed in the manufacture,
processing, or assembly of the products listed in 22 . Please review the entire list and report separately each item
consumed. Leave blank if you do not consume the item. If you use materials, parts, and supplies that are not listed,
describe and report them in the "Cost of all other materials . . . " at the end of this section. If you consumed less than
$25,000 of a listed material, include the value with "Cost of all other materials . . . " Census material code 009700 99 8.
Report materials, parts, and supplies purchased, transferred from other plants of your company, or withdrawn from
inventory.
If quantities are requested, please use the unit of measure specified.
If the information as requested cannot be taken directly from your book records, REASONABLE ESTIMATES ARE
ACCEPTABLE.
Valuation of Materials Consumed - The value of the materials, etc., consumed should be based on the delivered
cost; i.e., the amount paid or payable after discounts and including freight and other direct charges incurred in
acquiring the materials.
Materials received from other plants within your company should be reported at their full economic value (the value
assigned by the shipping plant, plus the cost of freight and other handling charges).
If purchases or transfers do not differ significantly from the amounts actually put into production, you may report
the cost of purchases or transfers. However, if consumption differs significantly from the amounts purchased or
transferred, these amounts should be adjusted for changes in the materials and supplies inventories by adding the
beginning inventory to the amount purchased or transferred and subtracting ending inventory.
Contract Work - Include as materials consumed those you purchased for use by others making products for you
under contract. Amounts paid to the companies doing the contract work should be reported in 15 , line A5, and should
include freight in and out. On the other hand, materials owned by others but used at this establishment in making
products for others under contract or on commission should be excluded.

Line No.

Resales - Cost for products bought and sold or transferred from other establishments of your company and sold
without further manufacture, processing, or assembly should be reported in 15 , line A2, not in 16 . The value of these
products shipped by this establishment should be reported in 22 under Census product code 000999 8900 6, "Resales."

Materials, parts, and supplies

Census material
code

Consumption of purchased
materials and of materials
received from other
establishments of your
company
Cost, including delivery cost
(freight-in)
$ Bil.

0634

0630

Mil.

Thou.

0631

Components for electronic circuitry, excluding tubes
1

Printed circuit boards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334412 00 4

2

Printed circuit assemblies, loaded boards or modules (printed circuit
boards with inserted electronic components) . . . . . . . . . . . . . . . . .

001900 C4 9

3

Semiconductors, including transistors, diodes, rectifiers, and integrated
circuits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334413 00 2

4

Capacitors

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334414 00 0

5

Resistors

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334415 00 7

33402082

Other components and accessories, nec (Specify kind.)
6

001900 D3 0

7

Electronic communication equipment . . . . . . . . . . . . . . . . . . . . . . . .

334220 01 9

8

Electrical instrument mechanisms and meter movements (including
instrument relays) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334515 01 2

CONTINUE WITH 16 ON PAGE 9
CONTINUE ON PAGE 9

Form MC-33402

Page 9

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.

Line No.

16 DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES - Continued

Census material
code

Materials, parts, and supplies

Consumption of purchased
materials and of materials
received from other
establishments of your
company
Cost, including delivery cost
(freight-in)
$ Bil.

0634

0630

9

Electronic computing equipment . . . . . . . . . . . . . . . . . . . . . . . . . . .

334100 01 3

10

Purchased peripheral storage devices . . . . . . . . . . . . . . . . . . . . . . . .

334112 00 0

11

Current-carrying wiring devices

. . . . . . . . . . . . . . . . . . . . . . . . . . .

335931 01 0

12

Insulated wire and cable (including magnet wire) . . . . . . . . . . . . . . . . .

331000 A7 4

13

Loud speakers, microphones, and tuners (all types)

334310 05 9

14

Fractional horsepower electric motors (less than 1 hp)

. . . . . . . . . . . . .

335312 11 2

15

Plastics resins consumed in the form of granules, pellets, powders, liquids,
etc., but excluding sheets, rods, tubes, and other shapes . . . . . . . . . . . .

325211 05 0

16

Fabricated plastics products (excluding gaskets, hoses, and belting)

. . . . .

326100 07 0

. . . . . . . . . . . . . . .

Mil.

Thou.

0631

Fabricated metal products (excluding forgings)
17

Sheet metal products (excluding stampings)

. . . . . . . . . . . . . . . . .

332000 A9 9

18

Bolts, nuts, screws, rivets, washers, and screw machine products . . . . .

332722 03 2

19

Metal stampings

332000 AC 2

20

Other fabricated metal products

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .

332000 33 0

21

Forgings

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

332100 01 5

22

Castings (rough and semifinished) . . . . . . . . . . . . . . . . . . . . . . . . . .

331000 35 6

23

Steel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

331200 01 4

24

Aluminum and aluminum-base alloy shapes and forms . . . . . . . . . . .

331000 39 8

25

All other nonferrous shapes and forms . . . . . . . . . . . . . . . . . . . . .

331000 77 8

33402090

Shapes and forms (excluding castings, forgings, and fabricated metal
products)

CONTINUE WITH 16 ON PAGE 10

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Form MC-33402

Page 10

Line No.

16 DETAILED COST OF MATERIALS, PARTS, AND SUPPLIES - Continued

Census material
code

Materials, parts, and supplies

Consumption of purchased
materials and of materials
received from other
establishments of your
company
Cost, including delivery cost
(freight-in)
$ Bil.

0634

26

0630

Paper and paperboard containers (including shipping sacks and other paper
packaging supplies) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mil.

Thou.

0631

322200 17 1

Cost of all other materials and components, parts, containers, and supplies
consumed (Specify the principal materials, etc., included in this value.)
27

28

009700 99 8

TOTAL (Should equal total reported in 15 , line A1)

. . . . . . . . . . . . . . .

771000 00 7

17 – 21 Not Applicable.
22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
General - The manufactured products and services listed below are generally made in your industry. If you make
products that are not listed, describe and report them in the "All other products made in this establishment" section at
the end of 22 . PLEASE DO NOT COMBINE PRODUCT LINES.
If quantities are requested, please use the unit of measure specified.
If the information as requested cannot be taken directly from your book records, REASONABLE ESTIMATES ARE
ACCEPTABLE.
Valuation of Products - Report the value of the products shipped and services performed at the net selling value,
f.o.b. plant to the customer; i.e., after discounts and allowances, and exclusive of freight charges and excise taxes.
If you transfer products to other establishments within your company, you should assign the full economic value to
the transferred products; i.e., include all direct costs of production and a reasonable proportion of all other costs and
profits.
Contract Work - Report PRODUCTS MADE BY OTHERS FOR YOU FROM YOUR MATERIALS on the specific product
lines as if they were made by you in this establishment. On the other hand, do not report on the specific product lines
PRODUCTS THAT YOU MADE FROM MATERIALS OWNED BY OTHERS. Report only the amount that you received
for "commission or contract receipts" for printed circuit boards under Census code 000930 0031 3, printed circuit
assemblies under Census code 000930 0032 1, and all other contract work receipts under Census code 000930 0014 9.
Report the amount that you received for other "commission or contract receipts" on line 12 Census code 000930 0000 8.
Do not report on the specific product lines for these products.

33402108

Detailed Data Reported Elsewhere - Items denoted by an asterisk (*) require totals for groups of products covered
in the more frequent Current Industrial Reports (CIR). If you report on the CIR form, the sum of the detailed products
should equal the total reported on this form. For corresponding survey item codes, see paragraph 4, "Comparability," of
CIR Instruction Manual.
NOTE: Only totals are requested; do not duplicate detail reported on the CIR.

CONTINUE WITH 22 ON PAGE 11

CONTINUE ON PAGE 11

Form MC-33402

Page 11

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.

Line No.

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
Products and services
*Items correspond to products reported on Current Industrial Reports (CIR)

Census product
code

Products shipped and other
receipts
Value, f.o.b. plant
$ Bil.

0730

1

Telephone switching and switchboard equipment (Corresponds to value
of shipments reported on CIR Form MA334P, Communication Equipment,
Including Telephone, Telegraph, and Other Electronic Systems and
Equipment, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334210 1100 9

2

Carrier line equipment (repeaters, line transceivers, multiplex equipment
including channel banks, analog and digital) and external modems for POTS,
ISDN, DSL, PSTN lines transmission (Corresponds to value of shipments
reported on CIR Form MA334P, Communication Equipment, Including
Telephone, Telegraph, and Other Electronic Systems and Equipment, for
2002.)*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334210 4100 6

3

External modems for individual PCs, consumer (Corresponds to value of
shipments reported on CIR Form MA334P, Communication Equipment,
Including Telephone, Telegraph, and Other Electronic Systems and
Equipment, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334418 4100 5

4

All other telephone and telegraph equipment, including telephone sets, data
communication equipment, telephone answering machines, and facsimile
communication equipment (Corresponds to value of shipments reported
on CIR Form MA334P, Communication Equipment, Including Telephone,
Telegraph, and Other Electronic Systems and Equipment, for 2002.)* . . . .

334210 7100 3

5

Communication systems and equipment, except broadcast, but including
microwave equipment such as transmitters, receivers, and amplifiers,
cellular systems and equipment both analog and digital, electronic support
equipment for communication systems, antenna systems, and space
satellites (Corresponds to value of shipments reported on CIR Form
MA334P, Communication Equipment, Including Telephone, Telegraph, and
Other Electronic Systems and Equipment, for 2002.)* . . . . . . . . . . . . . .

334220 1100 8

6

Broadcast, studio and related electronic equipment, except magnetic
recording and reproducing heads (Corresponds to value of shipments
reported on CIR Form MA334P, Communication Equipment, Including
Telephone, Telegraph, and Other Electronic Equipment, for 2002.)* . . . . . .

334220 2110 6

7

Magnetic recording and reproducing heads including audio, video, digital,
and instrumentation (Corresponds to value of shipments reported on CIR
Form MA334Q, Semiconductors, Printed Circuit Boards, and Other Electronic
Components, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334220 2120 5

8

Microwave components and devices, except antennae, tubes, and
semiconductors (Corresponds to the value of shipments reported on CIR
Form MA334Q, Semiconductors, Printed Circuit Boards and Other Electronic
Components, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334220 7100 2

9

Alarm systems, including electric sirens and horns (marine, industrial and
air raid), and security locking systems (Corresponds to value of shipments
reported on CIR Form MA334P, Communication Equipment, Including
Telephone, Telegraph, and Other Electronic Systems and Equipment, for
2002.)*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334290 1100 1

10

Vehicular and pedestrian traffic control equipment, electric railway signals
and attachments (Corresponds to value of shipments reported on CIR Form
MA334P, Communication Equipment, Including Telephone, Telegraph, and
Other Electronic Systems and Equipment, for 2002.)* . . . . . . . . . . . . . .

334290 2100 0

11

Intercommunications systems, including inductive paging systems
(Corresponds to value of shipments reported on CIR Form MA334P,
Communication Equipment, Including Telephone, Telegraph, and Other
Electronic Systems and Equipment, for 2002.)* . . . . . . . . . . . . . . . . . .

334290 3100 9

Mil.

Thou.

0731

33402116

0734

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CONTINUE ON PAGE 12

Form MC-33402

Page 12

Line No.

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
Products and services
*Items correspond to products reported on Current Industrial Reports (CIR)

Census product
code

Products shipped and other
receipts
Value, f.o.b. plant
$ Bil.

0730

12

Aeronautical, nautical, and navigational instruments, except aircraft engine
instruments (Corresponds to value of shipments reported on CIR Form
MA334B, Selected Instruments and Related Products, for 2002.)* . . . . . . .

334511 1100 0

13

Search and detection and navigation and guidance systems and equipment
(Corresponds to value of shipments reported on CIR Form MA334B, Selected
Instruments and Related Products, for 2002.)* . . . . . . . . . . . . . . . . . . .

334511 3100 8

14

Integrated microcircuits, including semiconductor networks,
microprocessors, and MOS memories (Corresponds to value of shipments
reported on CIR Form MA334Q, Semiconductors, Printed Circuit Boards, and
Other Electronic Components, for 2002.)* . . . . . . . . . . . . . . . . . . . . .

334413 1100 9

15

Other semiconductor devices, including semiconductor parts such as chips,
wafers, and heat sinks (Corresponds to value of shipments reported on CIR
Form MA334Q, Semiconductors, Printed Circuit Boards, and Other Electronic
Components, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334413 A100 9

16

Printed circuit boards and assemblies (Report contract work receipts for
work done by you for others on their own materials on lines 39 and 40.)
Printed circuit (wiring) boards (Corresponds to value of shipments
reported on CIR Form MA334Q, Semiconductors, Printed Circuit Boards,
and Other Electronic Components, for 2002.)* . . . . . . . . . . . . . . . . .

334412 0100 2

17

Printed circuit assemblies, loaded boards or modules (printed circuit
boards with inserted electronic components) (Corresponds to value of
shipments reported on CIR Form MA334Q, Semiconductors, Printed
Circuit Boards, and Other Electronic Components, for 2002.)* . . . . . . .

334418 A100 8

18

Transducers, electrical-electronic input/output, nec (Corresponds to value of
shipments reported on CIR Form MA334Q, Semiconductors, Printed Circuit
Boards, and Other Electronic Components, for 2002.)*
. . . . . . . . . . . . .

334419 4100 3

19

All other electronic components, nec, including delay lines, oscillators, static
power supplies, electronic cable harnesses and cable assemblies, liquid
crystal displays, magnetic cores, and sockets for electronic component
insertion, excluding home antenna, auto antenna, antenna accessories and
plotter controllers (Corresponds to value of shipments reported on CIR Form
MA334Q, Semiconductors, Printed Circuit Boards, and Other Electronic
Components, for 2002.) * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334419 E110 1

20

Home antenna, auto antenna, and antenna accessories, sold separately
(Corresponds to value of shipments reported on CIR Form MA334P,
Communication Equipment, Including Telephone, Telegraph, and Other
Electronic Systems and Equipment, for 2002.)* . . . . . . . . . . . . . . . . . .

334419 E120 0

21

Plotter controllers (Corresponds to value of shipments reported on CIR Form
MA334Q, Semiconductors, Printed Circuit Boards, and Other Electronic
Components, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334419 E130 9

22

Speakers, including loudspeaker systems and loudspeakers sold separately,
and commercial sound equipment (Corresponds to value of shipments
reported on CIR Form MA334M, Consumer Electronics, for 2002.)* . . . . . .

334310 4100 4

23

Host computers, multiusers (mainframes, super computers, medium scale
systems, UNIX and PC servers) (Corresponds to value of shipments reported
on CIR Form MA334R, Computers and Office and Accounting Machines, for
2002.)*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334111 1100 9

24

Single user computers, microprocessor-based, capable of supporting
attached peripherals (personal computers, workstations, portable computers)
(Corresponds to value of shipments reported on CIR Form MA334R,
Computers and Office and Accounting Machines, for 2002.)* . . . . . . . . . .

334111 7100 3

Mil.

Thou.

0731

33402124

0734

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CONTINUE ON PAGE 13

Form MC-33402

Page 13

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.

Line No.

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
Products and services
*Items correspond to products reported on Current Industrial Reports (CIR)

Census product
code

Products shipped and other
receipts
Value, f.o.b. plant
$ Bil.

0734

0730

25

Computer peripheral (input/output) equipment, nec, except parts,
attachments, and accessories (Corresponds to value of shipments reported
on CIR Form MA334R, Computers and Office and Accounting Machines, for
2002.)*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334119 1100 2

26

Electronic teaching machines, teaching aids, trainers, and simulators,
including kits (Corresponds to value of shipments reported on CIR Form
MA334P, Communication Equipment, Including Telephone, Telegraph, and
Other Electronic Systems and Equipment, for 2002.)* . . . . . . . . . . . . . .

333319 7100 3

27

Electronic systems and equipment, nec, including automatic garage door
openers and amplifiers (except audio, RF power, and video), except electric
fireplace logs and electric trouble lights (Corresponds to value of shipments
reported on CIR Form MA334P, Communication Equipment, Including
Telephone, Telegraph, and Other Electronic Systems and Equipment, for
2002.)*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

335999 C110 3

28

Test equipment for testing electrical, radio and communication circuits, and
motors (except portable instrument transformers) (Corresponds to value of
shipments reported on CIR Form MA334B, Selected Instruments and Related
Products, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334515 3100 9

29

Sighting, tracking, and fire-control equipment, optical-type (Corresponds to
the value of shipments reported on CIR Form MA334B, Selected Instruments
and Related Products, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . .

333314 1100 0

30

Aircraft engine instruments, except flight (except chronometers)
(Corresponds to value of shipments reported on CIR Form MA334B, Selected
Instruments and Related Products, for 2002.)* . . . . . . . . . . . . . . . . . . .

334519 1110 2

31

Chronometers (Corresponds to value of shipments reported on CIR Form
MA334B, Selected Instruments and Related Products, for 2002.)* . . . . . . .

334519 1120 1

32

Commercial, geophysical, meterological, and general purpose instruments
and equipment, except medical thermometers (Corresponds to value of
shipments reported on CIR Form MA334B, Selected Instruments and Related
Products, for 2002.)* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

334519 7100 7

Mil.

Thou.

0731

All other products made in this establishment - Specify and report each
product with sales value of $50,000 or more that cannot be assigned to
one of the "listed products and services". For all remaining products, write
"Other" and report a single total value.
18

33
26

34
34

33402132

35
42

36
59

37
67

38

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Form MC-33402

Page 14

Line No.

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE - Continued
Products and services
*Items correspond to products reported on Current Industrial Reports (CIR)

Census product
code

Products shipped and other
receipts
Value, f.o.b. plant
$ Bil.

0734

0730

Mil.

Thou.

0731

Contract work (Receipts for work done for others on their own materials)
39

Printed circuit (wiring) boards

. . . . . . . . . . . . . . . . . . . . . . . . . .

000930 0031 3

40

Printed circuit assemblies, loaded boards or modules (printed circuit
boards with inserted electronic components) . . . . . . . . . . . . . . . . .

000930 0032 1

All other receipts for work done for others on their materials (Specify
products worked on and kind of work.)

41

000930 0014 9

Miscellaneous receipts
42

Receipts for research and developmental work

. . . . . . . . . . . . . . . .

000999 8041 9

43

Other miscellaneous receipts (including repair work, except computer
maintenance and repair, installation, sales of scrap and refuse) . . . . . .

000999 8098 9

44

Resales - Sales of products bought and sold without further manufacture,
processing, or assembly (The cost of such items should be reported in 15 ,
line A2.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

000999 8900 6

45

TOTAL (Should equal

770000 0000 8

4

, line A) . . . . . . . . . . . . . . . . . . . . . . . . . . .

33402140

23 – 27 Not Applicable.

CONTINUE ON PAGE 15

Form MC-33402

Page 15

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.
28 ESTABLISHMENT ACTIVITIES
This activity was performed -

A. Indicate activities that were performed by this establishment
or were performed for this establishment by another company
during 2002.
(Mark "X" ALL that apply.)
1. Product design/engineering . . . . . . . . . . . . . . . .

By another
By this
establishment
establishment
of this
company

By another
company

Not at all

0921

8071

0941

0961

a. Bundling or kitting (combining multiple items into a
prepackaged product) . . . . . . . . . . . . . . . . .

0923

8072

0943

0963

b. Pick and pack (taking goods from inventory and
packaging them to fill orders) . . . . . . . . . . . . . .

0924

8073

0944

0964

c. Warehousing of finished products . . . . . . . . . . .

0925

8074

0945

0965

d. Breaking bulk (reducing large shipments into smaller
portions for customers) . . . . . . . . . . . . . . . .

0926

8075

0946

0966

e. Local delivery (within a city, town, or other local area,
including adjoining towns and suburban areas) . . . . .

0927

8076

0947

0967

f. Long distance delivery (beyond local areas and
commercial zones) . . . . . . . . . . . . . . . . . . .

0928

8077

0948

0968

g. Processing of returned merchandise . . . . . . . . . .

0932

8078

0952

0972

2. Order fulfillment

1. Manage inventory owned by this establishment AND held at
this location? . . . . . . . . . . . . . . . . . . . . . . .

0936

Yes

0937

No

2. Manage inventory owned by this establishment BUT held at
a customer's location? . . . . . . . . . . . . . . . . . . .

0956

Yes

0957

No

3. Manage inventory owned by another company BUT held at
this location? . . . . . . . . . . . . . . . . . . . . . . .

0976

Yes

0977

No

4. Manage inventory owned by another company AND held
somewhere other than at this location? . . . . . . . . . . .

0994

Yes

0995

No

5. Contract with another firm for any of your production using
materials owned by this location? . . . . . . . . . . . . .

8041

Yes

8042

No

6. Send any partially completed products to a foreign facility
for processing that were then returned to this establishment
for completion? . . . . . . . . . . . . . . . . . . . . . .

8044

Yes

8045

No

7. Manufacture products for a government to their
specifications? . . . . . . . . . . . . . . . . . . . . . .

8047

Yes

8048

No

8. Manufacture products for another business to their
specifications? . . . . . . . . . . . . . . . . . . . . . .

8016

Yes

8017

No

9. Manufacture products for a final retail customer to their
specifications? . . . . . . . . . . . . . . . . . . . . . .

8060

Yes

8062

No

CONTINUE ON PAGE 16

33402157

B. During 2002 did this establishment:

Form MC-33402

Page 16

29 OPERATIONAL STATUS
Activity that best describes this establishment's status at the end of 2002
(Mark "X" only ONE box.)
In operation

0011

Under construction,
development, or
exploration

0012

0060

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

Month

0018

Day

Year

Sold or leased to another operator Give date at right AND enter new name
and mailing address below

0015

Name of new owner or operator

0061

Employer Identification Number
Enter EIN of new
owner (9 digits)

0062

Mailing address (number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

-

State

0065

ZIP Code

Remarks (Please use this space for any explanations that may be essential in understanding your reported data.)

30 CERTIFICATION - This report is substantially accurate and was prepared in accordance with the instructions.

0078

Yes

0079

No - Enter time period covered

Month

Year

Month

FROM
0070

0072

Name of person to contact regarding this report

Area code
Telephone
0074
0076

Internet e-mail address

Number

-

0073

Year

TO

33402165

Is the time period covered by this report a calendar year?

0071

Title

Extension

Area code

Number

Fax

-

0075

Month

Date
completed

Day

0069

Thank you for completing your 2002 Economic Census form.
PLEASE PHOTOCOPY THIS FORM FOR YOUR RECORDS AND RETURN THE ORIGINAL.

Year