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POWER OF ATTORNEY

Check appropriate box

Individual

Corporation

General Partnership

Limited Partnership

Sole Proprietorship

Non-Resident of USA

Customs I.D.#

KNOW ALL MEN BY THESE PRESENTS: That,

(Full Name of person, partnership, or corporation. or sole proprietorship (Identify))

a corporation incorporated under the laws of the State of

or a

doing business as

residing at

haying an office and place of business at

, hereby constitutes and appoints each of the following persons

(Give full name of each agent designated)

as a true and lawful agent and attorney of the grantor named above for and in

said grantor, and any and all bonds which may be voluntarily given and

accepted under applicable laws and regulations, consignee’s and owner’s

the name, place, and stead of said grantor from this data and in Customs District

declarations provided for in section 485, Tariff Act of 1930, as amended, or

and in no other name, to make, endorse, sign, declare, or swear to any

entry, withdrawal, declaration, certificate, bill of lading, or other document

affidavits in connection with the entry of merchandise;

required by law regulation in connection with the importation, transportation, or

To sign and swear to any document and to perform any act that may

exportation of any merchandise shipped or consigned by or to said grantor; to

perform any act or condition which may be required by law or regulation in

be necessary or required by law or regulation in connection with the entering,

clearing, lading, unlading, or operation of any vessel or other means of

connection with such merchandise; to receive any merchandise deliverable to

said grantor;

conveyance owned or operated by said grantor;

And generally to transact at the customhouses in said district any and

To make endorsements on bill of lading conferring authority to make

entry and collect drawback, and to make, sign, declare, or swear to any

all customs business, including making, signing, and filing of protest under

section 514 of the Tariff Act of 1930, in which said grantor is or may be

statement, supplemental statement, schedule, supplemental schedule, certificate

concerned or interested and which may properly be transacted or performed

of delivery, certificate of manufacture, certificate of manufacture and delivery,

abstract of manufacturing records, declaration of proprietor on drawback entry,

by an agent and attorney, giving to said agent and attorney full power and

authority to do anything whatever requisite and necessary to be done in the

declaration of exporter on drawback entry, or any other affidavit or document

which may be required by law or regulation for drawback purposes, regardless of

premises as fully as said grantor could do if present and acting, hereby

ratifying and confirming all that said agent and attorney shall lawfully do by

whether such bill of lading, sworn statement, schedule, certificate, abstract,

virtue of the presents; the foregoing power of attorney to remain in full force

declaration, or other affidavit or document is intended for filing in said district or

in any other customs district;

and effect until the

day of

, 20

, or until notice of

revocation in writing is duly given to and received by the District Director of

Customs of the district aforesaid. If the donor of this power of attorney is a

To sign, seal, and deliver for and as the act of said grantor any bond

required by law or regulation in connection with the entry or withdrawal of

partnership, and said the power shall in no case have any force or effect after

the expiration of 2 years from the date of its receipt in the office of the district

imported merchandise or merchandise exported with or without benefit of

director of customs of the said district.

drawback, or in connection with the entry, clearance, lading, unlading or

navigation of any vessel or other means of conveyance owned or operated by

IN WITNESS WHEREOF, the said

has caused these presents to be sealed and signed: (Signature)

(Capacity)

(Date)

WITNESS:

(Corporate seal) *(Optional)

Customs Form 5291

Customs Form 3299 - Declaration For Free Entry Of Unaccompanied Articles, Supplemental Declaration For Unaccompanied Personal And Household Effects Etc. Page 4

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