FORM APPROVED OMB NO.
1651-0014
PAPERWORK REDUCTION ACT NOTICE: This
request is in accordance with the Paperwork Reduction Act. We ask for the
information in order to carry out the laws and regulations administered by the
CBP. These regulations and forms apply to importers to ensure that they are
complying with the law and to allow us to figure, collect, or refund the right
amount of duty and tax. It is mandatory. The estimated average burden associated
with this collection of information is 10 minutes per respondent depending on
individual circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be directed to the
Bureau of Customs and Border Protection, Information Services Branch,
Washington, DC 20229, and to the Office of Management and Budget, Paperwork
Reduction Project (1651-0014), Washington, DC 20503.
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.)
3. IMPORTER'S DATE OF
ARRIVAL
2. IMPORTER'S DATE OF
BIRTH
1. IMPORTER'S NAME (Last, first and
middle)
5. IMPORTER'S PORT OF
ARRIVAL
6. NAME OF ARRIVING VESSEL CARRIER AND
FLIGHT/TRAIN
4. IMPORTER'S U.S.
ADDRESS
7. NAME(S) OF ACCOMPANYING HOUSEHOLD
MEMBERS (wife, husband, minor children, etc.)
B. NAME OF
VESSEL/CARRIER
E. NUMBER AND KINDS OF
CONTAINERS
PART II -- TO BE COMPLETED BY ALL PERSONS
EXCEPT U.S. PERSONNEL AND EVACUEES
9. RESIDENCY ('X" appropriate
box)
I declare that my place of residence
abroad
C. RESIDENCY STATUS UPON MY/OUR ARRIVAL
("X" One)
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
C. Applicable to NONRESIDENT
ONLY
(1) All articles of apparel, personal
adornment, toiletries and similar personal effects
(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
period of use, and are not intended for any other person or for sale.
(9804.00.05, HTSUSA)
for which free entry is sought were
actually owned by me and in the possession of myself, or those members of my
family who accompanied me, at the time of departure to the United States and
that they are appropriate and are intended for our personal use and not for any
other person nor for sale. (9804.00.20 HTSUSA)
(2) AII instruments, implements, or
tools of trade, occupation or employment, and all
professional books for which free entry is
sought were taken abroad by me or for my account or I am an emigrant who owned
and used them abroad. (9804.00.10, 9804.00.15, HTSUSA)
(2) Any vehicles, trailers, bicycles
or other means of conveyance being imported are
for the transport of me and my family and
such incidental carriage of articles as are appropriate to my personal use of
the conveyance. (9804.00.35, HTSUSA)
B. Applicable to RESIDENT
ONLY
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 Government 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 D on the
reverse.)
A. For U.S. Personnel, Evacuees, Residents
and Non-Residents
B. For Residents and Non-Residents
ONLY
(1) Articles for the
account
(8) Foreign household effects
acquired
(7) Foreign household effects
acquired
abroad and used less than one
year.
abroad and used more than one
year.
(4) Alcoholic articles of
all
types or tobacco
products.
(9) Personal effects acquired
abroad.
(5) Fruits, plants,
seeds,
(6) Fish, wildlife,
animal
(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.
(11) Articles taken abroad for which
alterations or repairs were performed abroad.
DECLARATION FOR FREE
ENTRY
OF UNACCOMPANIED
ARTICLES
19
CFR 148.6, 148.52, 148.53, 148.77
D. B/L OR AWB OR I.T.
NO.
(This is a mandatory
field)
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U.S. DEPARTMENT OF HOMELAND
SECURITY
Bureau of Customs and Border
Protection
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