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Get Customs Declaration 2014 Form

This Space For Official Use Only U.S. Customs and Border Protection Welcomes You to the United States Customs Declaration 19 CFR 122. I HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION. X Signature Date month/day/year CBP Form 6059B 04/14 Total PAPERWORK REDUCTION ACT STATEMENT An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number. The control number for this collection is 1651-0009. The estimated average time to complete this application is 4 minutes. Your response is mandatory. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection Office of Regulations and Rulings 90 K Street NE 10th Floor Washington DC 20229. Failure to file the required report or failure to report the total amount that you are carrying may lead to the seizure of all the currency or monetary instruments and may subject you to civil penalties and/or criminal prosecution. SIGN ON THE OPPOSITE SIDE OF THIS FORM AFTER YOU HAVE READ THE IMPORTANT INFORMATION ABOVE AND MADE A TRUTHFUL DECLARATION. Description of Articles List may continue on another CBP Form 6059B Value CBP Use Only see definition of monetary instruments on reverse 14 I have We have commercial merchandise articles for sale samples used for soliciting orders or goods that are not considered personal effects 15 RESIDENTS the total value of all goods including commercial merchandise I/we have purchased or acquired abroad including gifts for someone else but not items mailed to the U.S. and am/are bringing to the U.S. is VISITORS the total value of all articles that will remain in the U.S. including commercial merchandise is Read the instructions on the back of this form. Space is provided to list all the items you must declare. 27 148. 12 148. 13 148. 110 148. 111 1498 31 CFR 5316 FORM APPROVED OMB NO. 1651-0009 Each arriving traveler or responsible family member must provide the following information only ONE written declaration per family is required. The term family is defined as members of a family residing in the same household who are related by blood marriage domestic relationship or adoption* 1 Family Name Middle First Given 2 Birth date Month Day Year 3 Number of Family members traveling with you 4 a U*S* Street Address hotel name/destination b City c State 5 Passport issued by country 6 Passport number 7 Country of Residence 8 Countries visited on this trip prior to U*S* arrival 9 Airline/Flight No* or Vessel Name 10 The primary purpose of this trip is business Yes No a fruits vegetables plants seeds food insects b meats animals animal/wildlife products c disease agents cell cultures snails d soil or have been on a farm/ranch/pasture 12 I have We have been in close proximity of livestock Yes 11 I am We are bringing such as touching or handling 13 I am We are carrying currency or monetary instruments over 10 000 U*S* or foreign equivalent United States against the illegal importation of prohibited items.

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