DEPARTMENT OF THE TREASURY UNITED STATES CUSTOMS SERVICE DECLARATION FOR FREE ENTRY OF UNACCOMPANIED ARTICLES 19 CPR 148.6, 148.52, 148.53, 148.77 JRM APPROVED OMG NO. 1515-9053 PAPERWORK REDUCTION ACT NOTICE: The paperwork Reduction Act of 1980 says we must tell you why we are collecting this information, how we will use it, amd whether you have to give it tous, We ask for the informatica to carry out the Customs Service laws of the United Stutes. We need it to exsure that importers are complying with these laws und to allow us to figure, collect, or refund the right amount of duty and tax. Your response is mandatory ‘The estimated average hurdea associated with this collection of information is 10 minutes per respondent oc recordkeeper depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to US. Customs Service, Paperwork Management Brasch, Washington DC 20229. DO NOT send completed form(s) to this office PART 1 - TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES (Please conswh with the Customs official for additional information or assistance. REMEMBER - All of your statements are subject to verification. Palse declarutions or failure to declare atackes could result in penalties } 1. IMPORTER'S NAME (Last, farst amd middle) Consignee Name Appearing on Invoice 4. IMPORTER US. ADDRESS Address Appearing on Invoice 2 IMPORTER'S DATE OF BIRTH 3. IMPORTER'S DATE OF ARRIVAL Consignee Birthday 3. IMPORTER'S PORT OF ARRIVAL Date Arriving In Country Airport or City of Arrival 6. NAME OF ARRIVING VESSEL/CARRIER AND PLIGHT/TRAIN Flight or Cruise Info (if applicable) 7. NAME(S) OF ACCOMPANYING HOUSEHOLD MEMBERS (wife, husband. minor chaldren, ete.) Persons Traveling with You 3. THE “OR WHI A. DATE FREE ENTRY IS CLAIMED BELONG TO ME ANDYOR MY FAMILY AND WERE IMPORTED Shipment Date & NUMBER AND KINDS OP CONTAINERS Number of Packages B. NAME OF VESSEL/CARRIER (Federal Express) P. MARKS AND NUMBERS (not applicable) C. PROM (Country) D. B/L or AWB of LT. NO. Country Shipment is Coming From PART I - TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES 9. RESIDENCY ("X” appropriate box} I declare that my place of residence abroad C. RESIDENCY STATUS UPON MY/OUR ARRIVAL ("X* One) (1) Returning resident of the US (2) Nonresident: 10. STATEMENT(S) OF ELIGIBILITY POR PREE ENTRY OF ARTICLES I the undersigned further declare that ("X* all applicable items and submis packing list’ A. Applicable to RESIDENT AND NONRESIDENT oO (1) All household effects acquired abeoad for which free entry is sought were used abroad for at least one year by me oc my fumily in a household of which I o my family was u resident member during such penod of use, and are not intended for any other persoa or for sale. (9904.00.05, HTSUSA} Oo (2) All instraments, implements, of tools of trade, occupation or employment, and all professional beaks for which free entry is sought were taken abeoad by me or for my account o [am am emigrant who awned and wsed them abroad. (9804.00.10. 9804.00.15, HTSUSA) B. Applicable to RESIDENT ONLY All personal effects for which free entry is sought were taken abroad by me or for my account. (9804.01.45, HTSUSA) A. NAME OP COUNTRY 8B. LENGTH OF TIME Country Visited and Length of Visit Ye Mo oO b. Visiting the U oO a, Emigrating 10 the U.S C. Applicable to NONRESIDENT ONLY oO (1) All articles of apparel, personal adomment, toiletries ad similar personal effects for which free entry is sought were actually owned by me and in the possession of myself or thase members of my family who accompanied me, at the time of departure to the United States und that they are appeopriute and are intended for our personal use aad tot far any o¢her person nor far sabe. (9804.00.24 HTSUSA} oO (2) Any vehicles, trailers, bicycles oc other means of conveyance being imported are for the transpoet of me and my family und such incidental carriage of articles as ate appeopriute 10 my personal use of the conveyance. (9804.(M).35, HTSUSA} PART Il - TO BE COMPLETED BY U.S 1, the undersigned, the owne the importer, of of a member of the importer's family residing with the impoete PERSONNEL AND EVACUEES ONLY nporter, or agent of the importer of the personal and household effects for which free entry is claimed, hereby certify that they were in direct persomal passessioa of hhile abroad, and that chey were imported into the United States because of the termination of assignenent to extended duty (as defined in section 148.7.44d) of the Castoms Regulations) at a post ar station outside the United States and the Customs Territory of the United States, or because of Government orders or instructions evucaating the imparter to the United States; and thar they are not imported for sale o¢ for the account of any other persom and that they do not include any alcoholic beverages of cigars. Free entry for these effects is claimed under Subheading No. 9805.00.50, Harmonized Tariff Schedule of the United States 1. DATE OF IMPORTER'S LAST DEPARTURE PROM THE US. PART IV - TO BE COMPLETED BY ALL PERSONS A. For U.S. Personnel, Evacuees, Residents and Non-Residents Oo (1) Articles for the account oO (2) Articles for sale o of other persoes commercial use oO (3) Firearms andioe oO (4) Aloabolic articles of all ammuszutioa types or tobacco products. ia (5) Fruits, plants, seeds, oO (6) Pish, wildlife, animal meats, or birds products thereof IEEKING FREE ENTRY OF ARTICLES licable stems wind bist 2. A COPY OP THE IMPORTER'S TRAVEL ORDERS IS ATTACHED AND THE ORDERS WERE ISSUED ON (Certain articles may be subject to duty and/oe other requirements amd ately in item D om the reverse.) B. For Residents and Non-Residents ONLY oO (7) Foreign household effects acquired oO (8) Foreign houschould effects acquired abroad and wsed ess than one year abroad and used more than one year C. For Resident ONLY Oj (9) Persanal effects acquired abroad E] (10) Foreign made seticles acquired in the United States and taken abroad on this trip ot acquired abroad on another trip that was previously declared to U.S. Customs O (11) Articles taken abroad for which alterations of repairs were performed abroad. Customs Form 3299 (100695) EFTA00286273

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D. LIST OF ARTICL (1) ITEM NUMBER CHECKED (2) DESCRIPTION OF MERCHANDISE IN PART IV, A. B.C. (4) FOREIGN, MERCHANDISE TAKEN ABROAD THIS TRIP: State where in the U.S. the foreign REPAIRS merchandise was acquired or when and where it was previously declared to U.S. Customs. Quantity of Items | Description of Items Value of Items | Brief description (purchased in US and taken on trip, now it is returning with me to the US) Please be sure | to list each item and its | value and | that the amounts match the invoice On the bottom | of this page include the | total value | of the shipment PART V - CARRIER’S CERTIFICATE AND RELEASE ORDER The undersigned carrier, to whom of upon whose order the urticles described in PART 1, 8. must be released, bereby certifies that the person named im Part J, 1.. is the owner ar coasignee af such articles within the parview of section 484(h), Tariff Act of 1930 In accordance with the provisions of section 484(h), Tariff Act of 1930, authority is hereby given to release the urticles to such consignee 1. NAME OF CARRIER SIGNATURE OF AGENT (Print and sign) Date " One oO A. Authorized Agent* (From facts obtained from the importer) kk] B. Importer 2. SIGNATURE Your Signature * An Authorized Agent is defined as a person who has actual knowledge of the facts and whe is specifically empowered under a power of attorney fo execute this declaration (see 19 CFR 141.19, 141.32, 141.33). 3.DATE L. SIGNATURE OF CUSTOMS OFFICIAL PART VII - CUSTOMS USE ONLY (Inspected and Released) Customs Form 3299 (100695)(Back) EFTA00286274