DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection DECLARATION FOR FREE ENTRY OF UNACCOMPANIED ARTICLES 19 CFR 148.6, 148.52, 148.53, 148.77 FORM APPROVED OMB NO. 1651-0014 Exp. 06-30-2016 Paperwork Reduction Act Statement: An not conduct or sponsor an information collection and a person is nal requved required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0014. The oe one Pen ine cine you can write to U.S. Customs and Border Protection of Regulations and Rulings, 799 9th Street, NW.. Washington DC 20229 PART = TO BE COMPLETED BY ALL PERSONS SEXING FREE ENTRY OF ARTICLES Crese coneatt wie Geo COP elise Sr adtoasl intonation oF assistance. REMEMBER-—Alll of your statements are subject to verification. False declarations or failure to declare articles could result in p 1. IMPORTER'S NAME (Last, first and middle) 2. IMPORTER'S DATE OF BIRTH Ngo 10-14-66 Lesley Groff June 11, 2019 4. IMPORTER'S U.S. ADDRESS 5. IMPORTER’S PORT OF ARRIVAL Teterboro Airport 9 East 71st Street, NY, NY 10021 6. NAME OF ARRIVING VESSEL CARRIER AND FLIGHT/TRAIN Private Plane Tail#N212JE 8. THE ARTICLES FOR WHICH 7. NAME(S) OF ACCOMPANYING HOUSEHOLD MEMBERS (wife, husband, minor children, etc.) FREE ENTRY IS CLAIMED BELONG TO ME AND/OR MY A. DATE B. NAME OF VESSELICARRIER | C. FROM (Country) FAMILY AND WERE IMPORTED Junell,'19 Federal Express usvI Sat re eae Or CONTAINERS F. MARKS AND NUMBERS D. B/L OR AWB OR LT. NO. PART Il - TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES $. RESIDENCY ("X" appropriate box) | declare that my place of residence abroad Cis I was C_ RESIDENCY STATUS UPON MYIOUR ARRIVAL ('X" One) 1) Returning resident of the U.S. (2) Nonresident: Oa S. C b. Visiting the WS. 10. CAT ee) On Denes’ Ecwne teen Genny Or ANI WLins the undersigned further deciare that (“X" all applicable items and submit packing list) : NAME OF COUNTRY B. LENGTH OF TIME USVI June 3-11,2019 A. hecitun eine asavoneidinas C. Applicable to NONRESIDENT ONLY (-](}) All household effects acquired abroad for which free entry is sought Le ee eee ise bo oy fel used abroad for at least one year by me or my family in a household of which | or my family was a resident member during such household of which | or any fannlly es a teaidenl senior desing eee, and are not for any other person or for sale. such period of use, and are not intended for any other person or for (9804.00.05, HTSUSA) sale. (9804.00.05, HTSUSA) All instruments, implements, or tools of trade, 1m tee panne me come, vehicies, trailers, bicycles or other means of conveyance being Chm Aes ll professional books for which free entry is sought were Cy Any von SSI 690. SNS RONDO Sis ane See ee ee abroad by me or for my account or | am an who owned and carnage of articles as are to my personal use of used them abroad .00.10,9804.00.15, ISA) conveyance. (9804.00.35, ) B. Applicable to RESIDENT ONLY All personal effects for which free entry is sought were taken abroad b: Pa aay ar (Se Ses GU if |, the undersigned, the owner, importer, or agent of the importer of the personal tacks Sor Sih Non Saat eres Dare eee eee ae wren ee praca ponsesnon tthe mero ofa mere of he wiganer ate Ny rr heey surnbing bene Beg adele ye into the United xa Gnnen Stames one On COP Toomans ves eg hep rnedhier Aid section 148.74(d) of the Customs Regulations) at a post or i United a station outside the the United States, or pe ciageiced ane aeeeeneesaneats United States; and that they are ia eeetan tar tale cx oc is tivend toy olla and that they do not include any alcoholic or cigars. Free entry for these effects is claimed under Subheading No. 9805.00.50, Harmonized Tariff Schedule of the United States. THE U.S. 2. ACOPY OF THE IMPORTER'S TRAVEL ORDERS IS ATTACHED AND 1. DATE OF IMPORTER'S LAST DEPARTURE FROM US. ae aL eet Ore PART IV - TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES (Certain be subject to duty and/or other requirements and must be specifically deciared herein. ode tp ph td a ey ey a A. For U.S. Personnel, Evacuees, Residents and Non-Residents 8. For Residents and Non-Residents ONLY 1) Articles for the account ) Articles for sale or (7) Fo household effects @) ign household effects : one year. 7 oO ® Finemms endior [] @) Acoheto exicies of a8 C. For Resident ONLY Fruits, plants, seeds, Fish, wildiffe, animal oO (9) Personal effects acquired abroad. O * ta shins oh Oe products thereof. {jo Foreign made articles acquired in the United States and taken abroad on this trip or acquired abroad on another trip that was previously deciared to CBP. Oa) Articles taken abroad for which alterations or repairs were performed abroad. CBP Form 3299 (10/09) EFTA00314124