Form 4345 PDF Details

Form 4345 is used to report a large number of different types of income and should be filed by taxpayers who have received more than $600 in any combination of the following types of income: independent contractor income, royalty income, insurance proceeds, and gambling or lottery winnings. The form must be filed even if the taxpayer didn't receive a Form 1099-MISC listing the income. Review the instructions carefully to ensure that all taxable income is reported. Penalties may apply for incorrect or incomplete information on Form 4345.

QuestionAnswer
Form NameForm 4345
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesus army corps of engineers 404 permit application, us army permit, illinois motorist report instructions, illinois accident report form

Form Preview Example

U.S. Army Corps of Engineers (USACE)

Form Approved -

 

APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT

OMB No. 0710-0003

33 CFR 325. The proponent agency is CECW-CO-R.

Expires: 01-08-2018

 

 

 

The public reporting burden for this collection of information, OMB Control Number 0710-0003, is estimated to average 11 hours 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR APPLICATION TO THE ABOVE EMAIL.

PRIVACY ACT STATEMENT

Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research, and Sanctuaries Act,

Section 103, 33 USC 1413; Regulatory Programs of the Corps of Engineers; Final Rule 33 CFR 320-332. Principal Purpose: Information provided on this form

will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies, and the public and may be made available as part of a public notice as required by Federal law. Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be issued. One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and/or instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned. System of Record Notice (SORN). The information received is entered into our permit tracking database and a SORN has been completed (SORN #A1145b) and may be accessed at the following website: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570115/a1145b-ce.aspx

(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)

1. APPLICATION NO.

 

 

 

2. FIELD OFFICE CODE

 

 

3. DATE RECEIVED

4. DATE APPLICATION COMPLETE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(ITEMS BELOW TO BE FILLED BY APPLICANT)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. APPLICANT'S NAME

 

 

 

 

 

 

8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)

First -

Middle -

 

 

Last -

First -

Middle -

Last -

Company -

 

 

 

 

 

 

Company -

 

 

 

 

 

E-mail Address -

 

 

 

 

 

 

E-mail Address -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. APPLICANT'S ADDRESS:

 

 

 

 

 

9. AGENT'S ADDRESS:

 

 

Address-

 

 

 

 

 

 

Address-

 

 

 

 

 

City -

State -

 

Zip -

 

Country -

City -

State -

Zip -

Country -

 

 

 

 

 

 

 

 

 

 

 

7. APPLICANT'S PHONE NOs. w/AREA CODE

 

 

10. AGENTS PHONE NOs. w/AREA CODE

 

 

a. Residence

b. Business

 

 

 

c. Fax

a. Residence

b. Business

 

c. Fax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATEMENT OF AUTHORIZATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. I hereby authorize,

 

 

 

 

 

 

to act in my behalf as my agent in the processing of this application and to furnish, upon request,

supplemental information in support of this permit application.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF APPLICANT

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY

 

 

 

 

 

 

 

 

 

 

 

 

 

12. PROJECT NAME OR TITLE (see instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

13. NAME OF WATERBODY, IF KNOWN (if applicable)

14. PROJECT STREET ADDRESS (if applicable)

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

15. LOCATION OF PROJECT

 

 

 

 

 

 

 

 

 

 

 

 

 

Latitude: ◦N

 

Longitude: ◦W

City -

 

State-

 

Zip-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)

 

 

 

 

 

 

 

 

State Tax Parcel ID

 

 

 

 

 

Municipality

 

 

 

 

 

 

 

 

Section -

Township -

 

 

Range -

 

 

 

 

 

ENG FORM 4345, MAY 2018

PREVIOUS EDITIONS ARE OBSOLETE.

Page 3 of 1

17. DIRECTIONS TO THE SITE

18. Nature of Activity (Description of project, include all features)

19. Project Purpose (Describe the reason or purpose of the project, see instructions)

USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED

20. Reason(s) for Discharge

21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:

 

Type

Type

Type

Amount in Cubic Yards

Amount in Cubic Yards

Amount in Cubic Yards

22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions) Acres

or

Linear Feet

23. Description of Avoidance, Minimization, and Compensation (see instructions)

ENG FORM 4345, MAY 2018

Page 3 of 2

24. Is Any Portion of the Work Already Complete?

 

Yes

 

No IF YES, DESCRIBE THE COMPLETED WORK

 

 

 

 

 

25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list).

a. Address-

 

City -

 

 

 

State -

 

 

 

Zip -

 

 

 

 

b. Address-

 

 

 

 

 

 

 

 

 

 

 

 

City -

 

 

 

State -

 

 

 

Zip -

 

 

 

 

c. Address-

 

 

 

 

 

 

 

 

 

 

 

 

City -

 

 

 

State -

 

 

 

Zip -

 

 

 

 

d. Address-

 

 

 

 

 

 

 

 

 

 

 

 

City -

 

 

 

State -

 

 

 

Zip -

 

 

 

 

e. Address-

 

 

 

 

 

 

 

 

 

 

 

 

City -

 

 

 

State -

 

 

 

Zip -

 

 

 

 

 

 

 

 

 

 

 

 

26. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application.

 

AGENCY

 

TYPE APPROVAL*

 

IDENTIFICATION

 

DATE APPLIED

 

DATE APPROVED

 

DATE DENIED

 

 

 

NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Would include but is not restricted to zoning, building, and flood plain permits

27. Application is hereby made for permit or permits to authorize the work described in this application. I certify that this information in this application is complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the applicant.

SIGNATURE OF APPLICANTDATESIGNATURE OF AGENTDATE

The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly authorized agent if the statement in block 11 has been filled out and signed.

18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.

ENG FORM 4345, MAY 2018

Page 3 of 3

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Be attentive when completing this pdf. Ensure every blank field is filled out correctly.

1. To start with, once filling out the illinois motorist report example, start in the form section that features the following fields:

Filling in segment 1 in usace 404 permit application form

2. Your next stage is usually to fill in the next few fields: PROJECT NAME OR TITLE see, NAME OF WATERBODY IF KNOWN if, PROJECT STREET ADDRESS if, LOCATION OF PROJECT, Latitude N, Longitude W, OTHER LOCATION DESCRIPTIONS IF, State Tax Parcel ID, Municipality, Address, City, State, Zip, Section, and Township.

usace 404 permit application form completion process detailed (stage 2)

3. Completing DIRECTIONS TO THE SITE, Nature of Activity Description of, and Project Purpose Describe the is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Project Purpose Describe the, DIRECTIONS TO THE SITE, and Nature of Activity Description of inside usace 404 permit application form

4. Completing Reasons for Discharge, Types of Material Being, Type Amount in Cubic Yards, Type Amount in Cubic Yards, Type Amount in Cubic Yards, Surface Area in Acres of Wetlands, Acres, Linear Feet, and Description of Avoidance is vital in this next step - don't forget to take the time and be mindful with each and every blank area!

Type Amount in Cubic Yards, Surface Area in Acres of Wetlands, and Type Amount in Cubic Yards in usace 404 permit application form

5. The last section to finalize this PDF form is crucial. You need to fill out the necessary form fields, such as Is Any Portion of the Work, Yes, No IF YES DESCRIBE THE COMPLETED, Addresses of Adjoining Property, a Address, City, b Address, City, c Address, State, State, Zip, and Zip, prior to using the file. Failing to do it could give you a flawed and potentially unacceptable document!

usace 404 permit application form writing process clarified (step 5)

Always be very attentive when completing State and No IF YES DESCRIBE THE COMPLETED, since this is where most people make mistakes.

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