EFTA00286275.pdf

FORM APPROVED OMB NO. 1651-0014 Exp. 06-30-2016 DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection DECLARATION FOR FREE ENTRY OF UNACCOMPANIED ARTICLES 19 CFR 148.6. 148.52. 148.53, 148.77 Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0014. The estimated average time to complete this application is 45 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection. Office of Regulations and Rulings. 799 9th Street. NW.. Washington DC 20229. PART I — TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES (Please consult with the CBP official for additional information or assistance. REMEMBER—All of your statements are subject to verification. False declarations or failure to declare articles could result in penalties.) 1. IMPORTERS NAME (Last, first and middle) 2. IMPORTER'S DATE OF BIRTH 3. IMPORTERS DATE OF ARRIVAL 4. IMPORTERS U.S. ADDRESS 5. IMPORTERS PORT OF ARRIVAL 6. NAME OF ARRIVING VESSEL CARRIER AND FLIGHT/TRAIN 7. NAME(S) OF ACCOMPANYING HOUSEHOLD MEMBERS (wife. husband. minor children, etc.) 8. THE ARTICLES FOR WHICH FREE ENTRY IS CLAIMED BELONG TO ME AND/OR MY FAMILY AND WERE IMPORTED E. NUMBER AND KINDS OF CONTAINERS A. DATE B. NAME OF VESSEL/CARRIER C. FROM (Country) D. B/L OR AWB OR I.T. NO. F. MARKS AND NUMBERS PART II - TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES 9. RESIDENCY ("X" appropriate box) A. NAME OF COUNTRY I declare that my place of residence abroad K is K was C. RESIDENCY STATUS UPON MY/OUR ARRIVAL ("X" One) K (1) Returning resident of the U.S. (2) Nonresident: 10. STATEMENT(S) OF ELIGIBILITY FOR FREE ENTRY OF ARTICLES I the undersigned further declare that ("X" all applicable items and submit packing list) : A. Applicable to RESIDENT and NONRESIDENT El (1) All household effects acquired abroad for which free entry is sought were used abroad for at least one year by me or my family in a household of which I or my family was a resident member during such B. LENGTH OF TIME Yr. Mo. K a. Emigrating to the U.S. K b. Visiting the U.S. C. Applicable to NONRESIDENT ONLY El (1) All household effects acquired abroad for which free entry is sought were used abroad for at least one year by me or my family in a household of which I or my family was a resident member during nod of use, and are not intended for any other person or for sale. such period of use, and are not intended for any other person or for (104.00.05. HTSUSA) sale. (9804.00.05. HTSUSA) 0(2) All instruments, implements, or tools of trade, occupation or employment. K (2) My vehicles, ballets, bicycles or other means of conveyance being and all professional books for which free entry is sought were taken imported are for the transport of me and my family and such incidental abroad by me or for my account or I am an emigrant who owned and carriage of articles as are appropriate to my personal use of the used them abroad. (9804.00.10.9804.00.15. HTSUSA) conveyance. (9804.00.35. HTSUSA) B. Applicable to RESIDENT ONLY El All personal effects for which free entry is sought were taken abroad by me or for my account. (9804.00.45. HTSUSA) PART III — TO BE COMPLETED BY U.S. PERSONNEL AND EVACUEES ONLY I. the undersigned, the owner, importer, or agent of the importer of the personal and household effects for which free entry is claimed, hereby certify that they were in direct personal possession of the importer, or of a member of the importer's family residing with the importer, while abroad, and that they were imported into the United States because of the termination of assignment to extended duty (as defined in section 148.74(d) of the Customs Regulations) at a post or station outside the United States and the CBP Territory of the United States, or because of Govemment orders or instructions evacuating the importer to the United States: and that they are not imported for sale or for the account of any other person and that they do not include any alcoholic beverages or cigars. Free entry for these effects is claimed under Subheading No. 9805.00.50. Harmonized Tariff Schedule of the United States. 1. DATE OF IMPORTER'S LAST DEPARTURE FROM THE U.S. 2. A COPY OF THE IMPORTER'S TRAVEL ORDERS IS ATTACHED AND THE ORDERS WERE ISSUED ON: PART IV - TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES (Certain articles may be subject to duty and/or other requirements and must be specifically declared herein. Please check all applicable items and list them separately in item Don the reverse.) A. For U.S. Personnel, Evacuees, Residents and Non-Residents K (1) Articles for the account K (2) Articles for sale or of other person. commercial use. K (3) Firearms and/or K (4) Alcoholic articles of all ammunition. types or tobacco products. K (5) Fruits. plants, seeds, meats, or birds. K (6) Fish. wildlife. animal products thereof. B. For Residents and Non-Residents ONLY El (7) Foreign household effects K (8) Foreign household effects acquired abroad and used less acquired abroad and used more than one year. than one year. C. For Resident ONLY El (9) Personal effects acquired abroad. 0(10) Foreign made articles acquired in the United States and taken abroad on this trip or acquired abroad on another trip that was previously declared to CBP. 0(11) Articles taken abroad for which alterations or repairs wore performed abroad. CBP Form 3299 (10/09) EFTA00286275 D. LIST OF ARTICLES (1) ITEM NUMBER (2) DESCRIPTION OF MERCHANDISE (3) VALUE OF (4) FOREIGN MERCHANDISE TAKEN ABROAD THIS CHECKED IN PART COST OF TRIP: State where in the U.S. the foreign merchandise IV, A.. B.. C. REPAIRS was acquired or when and where it was previously declared to CBP. PART V — CARRIER'S CERTIFICATE AND RELEASE ORDER The undersigned carrier, to vhom of upon whose order the articles described in PART I. 8.. must be released, hereby certifies that the person named in Part I. 1.. is the owner or consignee of such articles within the purview of section 484(h). Tariff Act of 1930. In accordance with provisions of section 484(h). Tariff Act of 1930. authority is hereby given to release the articles to such consignee. 1. NAME OF CARRIER 2. SIGNATURE OF AGENT (Print and sign) Date PART VI — CERTIFICATION TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY I. the undersigned. certify that this declaration is correct and complete. 1. 'X' One 0 A. Authorized Agent' (From facts obtained from the importer) O B. Importer 2. SIGNATURE 3. DATE An Authorized Agent is defined as a person who has actual knowledge of the facts and who is specifically empowered under a power of attorney to execute this declaration (see 19 CFR 141.19. 14 f.32. 141.33). PART VII - CBP USE ONLY (Inspected and Released) 1. SIGNATURE OF CBP OFFICIAL 2. DATE CBP Form 3299 (10/09) EFTA00286276