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Customs Form 3299 - Declaration For Free Entry Of Unaccompanied Articles. Supplemental Declaration For Unaccompanied Personal And Household Effects Etc. Page 2

D. LIST OF ARTICLES

(1) ITEM NUMBER CHECKED

(2) DESCRIPTION OF MERCHANDISE

(3) VALUE OR

(4) FOREIGN MERCHANDISE TAKEN ABROAD

THIS TRIP: State where in the U.S. the foreign

IN PART IV, A., B., C.

COST OF

merchandise was acquired or when and where it

REPAIRS

was previously declared to U.S. Customs.

PART V -- CARRIER'S CERTIFICATE AND RELEASE ORDER

The undersigned carrier, to whom 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 the 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

A. Authorized Agent* (From facts obtained from the importer)

B. Importer

3. DATE

2. SIGNATURE

*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, 141.32, 141.33).

1. SIGNATURE OF CUSTOMS OFFICIAL

2. DATE

PART VII -- CUSTOMS USE ONLY

(Inspected and Released)

Customs Form 3299 (100695)(Back)