EFTA00286273.pdf

FORM APPROVPIN (ma tin 1b1-, nn DEPARTMENT OF THE TREASURY UNITED STATES CUSTOMS SERVICE DECLARATION FOR FREE ENTRY OF UNACCOMPANIED ARTICLES I9CFR 148.6.148 52. 148.51 148.T7 PAPERWORK REDUCTION ACTNOTICE The paperwork Rt.:Yawn Aa of 1980 says we must tell you why nu are collecting this miaow:ca. how an nil use a. asd whether you have to Base a to us. We ask for the information to carry our the Customs Service laws of the United Sleet. We need 4 to mousy that importers are complying with that laws and to allow us to limn. collector refund the right .unotim of duty and tax You response a mandates) The estimated average burden athauted with this collation of alternation as In Metes per respondent a recordkaper depending on individual circumstances Cimments concerning the accuracy of this burdenestimate and suggestions for reducing this burden should be directed to U S Cumin). Service. Paperwork hlanagcmcm Brash Washington DC 2=1. DO NOT and compkad form(sIlle this Slice PART I - TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES 'Heath consult with the Cuthous dheial Ciraddniamlinformation nr altteiCe. REMEMBER • All at your surcutenu are subject to renticalon. Ethe declarationsor hart todeclare article% caild rewh in penalties. I I. IMPORTERS NAME Mass. first and midlle/ Consignee Name Appearing on Invoice 1 IMPORTERS DATE OF BIRTH Consignee Birthday I IMPORTERS DATE OF ARRIVAL Date Arriving In Country 4. IMPORTER US. ADDRESS Address Appearing on Invoice 5. IMPORTERS PORT OF ARRIVAL Airport or City of Arrival & NAME Of ARRIVING VESSEUCARRIER AND FLIGI MAIN Flight or Cruise Info (if applicable) SANIIAS 01 Alt ONIPANIr I IOUSEHOLD MEMBERS lade. husband. minor children. etc) Persons Traveling with You 8 THE ARTICLES FOR WHICH FREE. ENTRY IS CLAIMED BELO/OCT° ME AMOR MY FAMILY AND WERE IMPORTED E. NUMBER AND KINDS OP COMAINER.S 4 A. DATE Shkialtill DSO B. NAME Of VESSELCARRIER (Federal Express) C. PROM (foamy) Country Shipment is Corning From D Bfl.ce AWB os I T NO. Number of Packages P. MARKS AND NUMBERS (not applicable) PART II - TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES 9. RESIDENCY l'%" appeopnaU box) I declare that my place of residence abroad 0 is was 4 A. NAME 012 COUNTRY B. LENGTH OF TIME Country Visited and Length of Visit Yr. C. RESIDENCY STATUS UPON MY/OUR ARRIVAL CX' One) O , I) Retursing modern of the US. 121Notwesidem ID a. Emigrating to the U.S. 10. STATEMENTISI OP ELIGIBILITY FOR FREE ENTRY °PARTICLES 1 the undersigned further declare that Cr all applicable atm and submit parkin liar} A. Applicable to RESIDENT AND NONRESIDENT El I I)All householddials acquiredabroad for which free entry is sought were used abroad for at least one you by me a my family in a household of which I a my family was a leaden member dunng such period of use. and are nut ittathed for any other person or fa sale 0804 00 05.11TSUSAt K 121Allotaramems. implements. a tools of lade. occupation a employmem. and all professional bath la which free emry is sought were taken abroad by me a foe my accoum a I am anemigrant who owned and used them abroad, (95010.10. 9801(0, I5. HTSUSA) b Vasthas the US. H. Applicable to RESIDENT ONLY (Ilea. for +barb are entry u re ;amid by men for my a•sount 19804 00.45. HTSUSA) C. Applicable to NONRESIDENT ONLY (I ) All amok, of apparel. pentad adornment. tittle% and sinula personal effects for Mach free entry is sought were actually owned by me and in the possession of myself. a those members of my family who accompanied me. at the time el.denature tothe limed States and that they ate appapthe and are mended for as personal use and not for any calm person not for sale. (9804.0020 IITSUSA1 K (2) Any vehicles. molar. bicycles a other means of conveyance bang impaled are for the untspon of me and my family and such incidental menageof articles as are apthimithe to my personal use of the conveyance. 19801.00.15. IfTSUSAt PART III -TO BE COMPLETED BY US. PERSONNEL AND EVACUEES ONLY I. the undersigned. the owner. impeder. or agent of the moaner of the personal and householddiens for whic free entry as claimed. hereby certifythat they was in direct personal possessionof the importer. a of a member of the impalas family residing with the im parter. while abroad and that they at e imported into the United Styes because of the termination of assignment to extended duty las defined in talon WS 74alp of the Customs Regulations, at a post or melon outside the United States ad the Customs Territory of the United Stith. or because of Gosernmem orders or instructions erapuung the importer to the Coiled State, and that they are not impaled or sale or for the accoum of any other person and that they do not includeany alcoholic beverages or cigars Free entry for these effects is:Limed der Subheading No.9805.0030i Ithmonued Tad/ Schedule ot the United Stan. 1. DATE Of IMPORTERS LAST DEPARTURE FROM THE U S 2. A COPY OF THE IMPORTER'S TRAVEL ORDERS IS ATTACHEDAND THE ORDERS WERE ISSUED ON: PART IV - TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES iCenan rucks maybe subject to duty and/or other reepthernenu and mat be speci(wally declared herein Please check all 'cable need and lot them searateb in item Don the reverse.) A. For U.S. Personnel. Evacuees. Residents and Non-Residents ▪ III Articles for the accoum O 12i Articles for sale a of other moons commercial use ▪ di Firmmo andhe Hi Alcoholic thickset an ammunatun types or tobacco poilwas ▪ 151Frum. plats. seeds. means. a huts El 16I Pah. wildlife. Jetted products thereof. B. For Residents and Non-Residents ONLY K 01 Famish hanehold <Hems acquired 181Foreign househouki &cob acquired abroad and used than one you. abroad and used more than one year. C. For Resident ONLY ▪ (9) Personal effects acquired thread. El (I0) Foreign made attacks acquired in the Celled Sett and taken abroal on has nip or acquiredabroad on another nip Ilul was previously declared to S ClItlettlt K I I I l Articles mbar abroad for which alterations or upon were perfarned abroad. Customs Form 3299110069') EFTA00286273 D LIST OF ARTICLES (I) ITEM NUMBER CHECKED IN PART IV.A.. B.. C. 121DESCRIPTION OP MERCHANDISE 131 VALUE OR COST OF REPAIRS (di FOREIGN. MERCHANDISE TAKEN ABROAD MIS TRIP: Same U.S.theft:reign 'therein the merchandise Was argot:14er when end where it was preriousls declared to U.S.Cattoms. Quantity of Items Please be sure On the bottom Description of Items to list each item and its of this page include the Value of Items value and total value Brief description (purchased in US and taken on trip. now it is returning with me to the US) that the amounts match the invoice of the shipment PART V - CARRIER'S CERTIFICATE AND RELEASE ORDER The undersigned caner. to whom or upon whose coder the articles descnbcd in PART I. B. must be releaseel.bereby caulk,' that the person named a Pan I. I.. is the ownes os consignee of such uncles within the praysew of section 4840). Ting An of 1930 In accordance with the prosimons of section Ht.tito. Tani( An of 1930. authosity is hereby peon to release the unifies to such commerce. I. NAME OF CARRIER I. SIGNATURE OF AGENT (Print and do) Dale PART VI - CERTIFICATION TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY Labe undersigned. cerafv that thes theta/igloo Is cornet and complige. I. 'X" One 0 A. Authorized Aver thorn facts obtained from the importer, B. Importer 2. SIGNATURE Your Signature 3. DATE • An .1uthartzed Agent it *OS as a person who has actual knowledge of Melon's ad who is spear fluff( empowered under a power of attorney to execute Ow declaration (see l9 CFR 141.10. itt32. 141.319 I. SIGNATURE OF CL STOAIS OFFICIAL PAK VII - CUSTOMS USE ONLY (Inspected and Released! 2. DATE. Customs Form 3299 (10069S)IBack) EFTA00286274