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41, 123.4, 143.23, 145.35 1. PORT 2. DATE 3. ENTRY NO. & DATE 4. NAME OF MANUFACTURER 5, CITY AND STATE OF MANUFACTURE 6. REASON FOR RETURN 7. U.S. DRAWBACK PREVIOUSLY CLAIMED UNCLAIMED 8. PREVIOUSLY IMPORTED UNDER TSUSA 864.O5? YES 9. MARKS, NUMBERS, AND DESCRIPTION OF ARTICLES RETURNED NO 10. VALUE* * If the value of the article is $10,000 or more and the articles are not clearly marked with the name and address of U.S. manufacturer, please attach copies of any documentation or o evi.

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