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

NOAA FORM 34-82
OMB NO 0648-0041
Expires: 06/30/2022

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
Name:

Mail report and tax return copy to:

Capital Construction Fund Program
DEPOSIT/WITHDRAWAL REPORT

NOAA Fisheries F/MB5
Capital ConstructionFund Program
1315 East-West Highway
Silver Spring, MD 20910-3282
301-713-2393
301-427-8784

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.

AGREEMENT HOLDER:

CCF CASE NUMBER

Name :

CCF -

-

Address:
City and State :

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 Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be
subject to a penalty for failure to comply with an information collection subject to the requirements of the
Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number.
The approved OMB Control Number for this information collection is 0648-0041. Without this approval, we
could not conduct this information collection. Public reporting for this information collection is estimated to be
approximately 2 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the information collection.
All responses to this information collection are required to obtain benefits. Send comments regarding this burden
estimate or any other aspect of this information collection, including suggestions for reducing this burden to the
NOAA Fisheries, F/MB5, 1315 East West Hwy., Silver Spring, MD 20910, Attn: Richard VanGorder, and
Richard.VanGorder@noaa.gov if desired.

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

/