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DEPARTMENT OF THE TREASURY

FORM APPROVED OMB NO. 1515-0053

United States Customs Service

Paperwork Reduction Act Notice: This request is in accordance with the Paperwork Reduction Act of

1995. We ask for the information in order to carry out the laws and regulations administered by the U.S.

Customs Service. These regulations and forms apply to importers to ensure that they are complying with

DECLARATION FOR FREE ENTRY

the law and to allow us to figure, collect, or refund the right amount of duty and tax. It is mandatory. The

OF UNACCOMPANIED ARTICLES

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 estimates

and suggestions for reducing this burden should be directed to the U.S. Customs Service, Information

Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork

19 CFR 148.6, 148.52, 148.53, 148.77

Reduction Project (1515-0053), Washington, DC 20503.

PART I -- TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES

(Please consult with the Customs 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. IMPORTER'S NAME (Last, first and middle)

2. IMPORTER'S DATE OF BIRTH

3. IMPORTER'S DATE OF ARRIVAL

4. IMPORTER'S U.S. ADDRESS

5. IMPORTER'S 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

A. DATE

B. NAME OF VESSEL/CARRIER

C. FROM (Country)

D. B/L OR AWB OR I.T. NO.

FREE ENTRY IS CLAIMED

BELONG TO ME AND/OR MY

FAMILY AND WERE IMPORTED

E. NUMBER AND KINDS OF CONTAINERS

F. MARKS AND NUMBERS

PART II -- TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES

A. NAME OF COUNTRY

B. LENGTH OF TIME

9. RESIDENCY ('X" appropriate box)

was

I declare that my place of residence abroad

Yr.

Mo.

C. RESIDENCY STATUS UPON MY/OUR ARRIVAL ("X" One)

(1) Returning resident of the U.S.

a. Emigrating to the U.S.

b. Visiting 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

C. Applicable to NONRESIDENT ONLY

(1) All household effects acquired abroad for which free entry is sought were used

(1) All articles of apparel, personal adornment, toiletries and similar personal effects

abroad for at least one year by me or my family in a household of which I or my

for which free entry is sought were actually owned by me and in the possession of

family was a resident member during such period of use, and are not intended

myself, or those members of my family who accompanied me, at the time of

for any other person or for sale. (9804.00.05, HTSUSA)

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

(2) Any vehicles, trailers, bicycles or other means of conveyance being imported are

my account or I am an emigrant who owned and used them abroad. (9804.00.10,

for the transport of me and my family and such incidental carriage of articles as

9804.00.15, HTSUSA)

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 Customs 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

(7) Foreign household effects acquired

(8) Foreign household effects acquired

(1) Articles for the account