Cbp Form 216 - Application For Foreign-Trade Zone Activity Permit

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OMB Control Number: 1651-0029; Expiration Date: 10/31/2018

DEPARTMENT OF HOMELAND SECURITY

1. ZONE NO. AND LOCATION (Address)

U.S.Customs and Border Protection

APPLICATION FOR

FOREIGN-TRADE ZONE

ACTIVITY PERMIT

2. ZONE ADMISSION NO.

3. APPLICATION DATE

19 CFR 146.52, 146.66

4. TYPE OF ACTIVITY FOR WHICH PERMIT REQUESTED

Manipulate

Manufacture

Exhibit

Destroy

Temporary Removal

5. FULL DESCRIPTION OF THE ACTIVITY (Include designation of the exact place in zone where the operation is to be performed and, in the case of a

proposed manipulation or manufacture, a statement as to whether merchandise with one zone status is to be packed, commingled, or combined with

merchandise having different zone status. If additional space required, attach separate sheet. If first application for manufacturing of this kind, state whether

Foreign-Trade Zones board has occurred in proposed operation.)

10.

11.

ZONE LOT NO.

MARKS AND

WEIGHTS,

OR UNIQUE

DESCRIPTION OF MERCHANDISE

QUANTITY

ZONE

NUMBERS

MEASURES

IDENTIFIER

STATUS

If any merchandise is to be manipulated in any way or manufactured, I agree to maintain the records provided for in sections 146.21(a), 146.23, and 146.52(d)

of the Customs Regulations and to make them available to CBP officers for inspection.

12. APPLICANT FIRM NAME

13. BY (Signature)

14. TITLE

15. BY (Signature)

16. TITLE

APPROVED BY FOREIGN-

TRADE ZONE OPERATOR

PERMIT

The application made above is hereby approved and permission is granted to manipulate, manufacture, exhibit, destroy, or temporarily removed, as

requested, on condition that the applicable regulations are complied with and the records required to be maintained will be available for inspection.

17. PORT DIRECTOR OF CBP: By (Signature)