Customs Declaration And Dispatch Note Cp 72 Page 5
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8United States Postal Service
®
Customs Declaration and Dispatch Note — CP 72
IMPORTANT: This item may be opened officially. Please print in English, using blue or black ink, and press
firmly; you are making multiple copies. See Privacy Notice and Indemnity Coverage on Sender’s Copy.
FROM:
Sender’s Last Name
First
MI
Insured Amount (US $)
SDR Value
.
.
/
/
0
0
$
Business
Insurance Fees (US $) Total Postage/Fees (US $)
.
.
$
$
Address (Number, street, suite, apt., P.O. Box, etc. Residents of Puerto Rico include Urbanization Code preceeded with URB.)
13. Sender’s Customs Reference (If any)
City
State
ZIP+4
®
14. Importer’s Reference - Optional (If any)
Telephone/Fax or Email
15. Importer’s Contact (select one)
Telephone Fax Email
TO:
Addressee’s Last Name
First
MI
Business
Declaration by ADDRESSEE: I have received the parcel
described on this note. ADDRESSEE’S Signature and Date
Month Day
Year
Address (Number, street, suite, apt., P.O. Box, etc.)
Postcode
City
18. Invoice No.
State/Province
Country
Please affix labels here when required.
Office of Exchange
Customs Stamp
Customs Duty
5. Check All That Apply:
6. Other Restrictions:
9. If non-deliverable:
Mailing Office Date Stamp
7. Total Gross
8. Total Value US $
Dangerous
(pertains to No. 11)
Gift
Returned Goods
Wt: (all items
(all items)
Treat as Abandoned
Goods
Lbs. & Ozs.)
.
.
Documents
Commercial Sample
Return to Sender
Merchandise
Humanitarian Donation
Other
Redirect to Address Below
10. AES/ITN/Exemption
11. Restrictions:
Quarantine
Sanitary or Phytosanitary Inspection
12. I certify the particulars given in this customs declaration are correct. This item does not contain any undeclared dangerous
articles, or articles prohibited by legislation or by postal or customs regulations. I have met all applicable export filing requirements
under federal law and regulations. Sender’s Signature and Date
Month Day
Year
2976-A,
PS Form
July 2013 PSN 7530-01-000-9834
Do not duplicate this form without USPS
®
approval.
3 – Dispatch Note
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