EFTA00286273.pdf

FORM APPROVPIN (ma tin 1b1-, nn DEPARTMENT OF THE TREASURY 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 UNITED STATES CUSTOMS SERVICE 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) DECLARATION FOR FREE ENTRY The estimated average burden athauted with this collation of alternation as In Metes per respondent a recordkaper depending on individual circumstances Cimments concerning OF UNACCOMPANIED ARTICLES 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 I9CFR 148.6.148 52. 148.51 148.T7 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/ 1 IMPORTERS DATE OF BIRTH I IMPORTERS DATE OF ARRIVAL Consignee Name Appearing on Invoice Consignee Birthday Date Arriving In Country 4. IMPORTER US. ADDRESS 5. IMPORTERS PORT OF ARRIVAL Address Appearing on Invoice Airport or City of Arrival & NAME Of ARRIVING VESSEUCARRIER ANDFLIGI MAIN Flight or Cruise Info (if applicable) SANIIAS 01 Alt ONIPANIr IIOUSEHOLD MEMBERS lade. husband. minor children. etc) Persons Traveling with You 8 THE ARTICLES FOR WHICH A. DATE B. NAME Of VESSELCARRIER C. PROM (foamy) D Bfl.ce AWB os I T NO. FREE. ENTRY IS CLAIMED BELO/OCT° ME AMOR MY Shkialtill DSO (Federal Express) Country Shipment is Corning From FAMILY AND WERE IMPORTED 4 E. NUMBER AND KINDS OP COMAINER.S P. MARKS AND NUMBERS Number of Packages (not applicable) PART II - TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES 9. RESIDENCY l'%" appeopnaU box) A. NAME 012 COUNTRY B. LENGTH OF TIME I declare that my place of residence abroad 0 is was 4 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. b Vasthas the US. 10. STATEMENTISI OP ELIGIBILITY FOR FREE ENTRY °PARTICLES 1the undersigned further declare that Cr all applicable atm and submit parkin liar} A. Applicable to RESIDENT AND NONRESIDENT C. Applicable to NONRESIDENT ONLY El II)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 (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. family was a leaden member dunng such period of use. and are nut ittathed for a those members of my family who accompanied me. at the time el. denature tothe any other person or fa sale 0804 00 05.11TSUSAt 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 ❑ 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 ❑ (2) Any vehicles. molar. bicycles a other means of conveyance bang impaled are for my accoum a I am anemigrant who owned and used them abroad, (95010.10. the untspon of me and my family and such incidental menageof articles as are 9801(0, I5. HTSUSA) apthimithe to my personal use of the conveyance. 19801.00.15. IfTSUSAt H. Applicable to RESIDENT ONLY (Ilea. for +barb are entry u re ;amid by men for my a•sount 19804 00.45. HTSUSA) 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 B. For Residents and Non-Residents ONLY ▪ III Articles for the accoum O 12i Articles for sale a ❑ 01Famish hanehold <Hems acquired 181Foreign househouki &cob acquired of other moons commercial use abroad and used than one you. abroad and used more than one year. ▪ di Firmmo andhe Hi Alcoholic thickset an C. For Resident ONLY ammunatun types or tobacco poilwas ▪ (9) Personal effects acquired thread. El (I0) Foreign made attacks acquired in the Celled Sett and taken abroal on has nip or ▪ 151Frum. plats. seeds. means. a huts El 16I Pah. wildlife. products thereof. Jetted acquiredabroad on another nip Ilul was previously declared to S ClItlettlt ❑ 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 121DESCRIPTION OP MERCHANDISE 131 VALUE OR (di FOREIGN. MERCHANDISE TAKEN ABROAD IN PART IV.A.. B.. C. COST OF MIS TRIP: Same 'therein the U.S.theft:reign REPAIRS merchandise Was argot:14er when end where it was preriousls declared to U.S.Cattoms. Quantity of Items Description of Items Value of Items Brief description (purchased in US and taken on trip. now it is returning with me to the US) Please be sure to list each item and its value and that the amounts match the invoice On the bottom of this page include the total value of the shipment PART V - CARRIER'S CERTIFICATE AND RELEASE ORDER The undersigned caner. to whom or upon whose coder the articles descnbcd in PARTI. 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 A. Authorized Aver thorn facts obtained from the importer, B. Importer 0 2. SIGNATURE 3. DATE Your Signature • An .1uthartzed Agent it *OS as a person who has actual knowledge ofMelon's ad who is spearfluff( empowered under a power of attorney to execute Ow declaration (see l9 CFR 141.10. itt32. 141.319 I. SIGNATURE OF CL STOAIS OFFICIAL 2. DATE. PAK VII - CUSTOMS USE ONLY (Inspected and Released! Customs Form 3299 (10069S)IBack) EFTA00286274