Usda Lacey Act Declaration Page 3
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4Version 12-08-2008-0856
1.
Estimated Date of Arrival: Enter the date (MM/DD/YYYY) that the product is expected to
enter the United States of America.
2.
Entry Number: Enter the U. S. Customs entry number assigned to this shipment.
(Format: xxx-xxxxxxx-x)
3.
Container Number: Enter the number of the shipping container in which the product is being
shipped - available from your shipping company. If there is no container number, please leave
this section blank.
4.
Bill of Lading: Enter the Bill of Lading (BOL) number assigned to this shipment - available from
the shipping company. If there is no Bill of Lading number, please leave this section blank.
5.
MID: Manufacturer Identification Code - available from the manufacturer or customs broker
(19 CFR Appendix to Part 102).
6.
Importer Name: Enter the name of the import company or individual for the product.
7.
Importer Address: Enter the address of the import company or individual in #6.
8.
Consignee Name: Name of the individual or company who ordered and will ultimately receive
the shipment.
9.
Consignee Address: Enter the address of the individual or company in #8.
10.
Description of the Merchandise: Enter the name of the plant or plant product, and its use
(example: floral arrangement for decorative purposes).
11.
HTSUS Number: Enter the Harmonized Tariff Code for the merchandise described in #10
- available at
12.
Entered Value (in U.S. Dollars): Write the entered value of the imported merchandise described
in #10 in U.S. Dollars.
13.
Article/Component of Article: Enter a brief description of each article, or component of an article,
that is manufactured from plants or plant parts. (Example: A decorative item including a wood
frame and 100 % recycled paperboard - enter the frame as a line item, and record the percent
recycled material in the paperboard in section #13.)
14.
Plant Scientific Name: For each article/component in #14 enter the scientific name (example:
See next page). If the species of plant used to produce the product varies, and the species used to
produce the product is unknown, enter each species that may have been used to produce the product.
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