Entry Summary: U.S. Customs and Border Protection
Entry Summary: U.S. Customs and Border Protection
Entry Summary: U.S. Customs and Border Protection
1651-0022
EXPIRATION DATE 01/31/2021
U.S. Customs and Border Protection ESTIMATED BURDEN 10 MIN
8. Importing Carrier 9. Mode of Transport 10. Country of Origin 11. Import Date
12. B/L or AWB No. 13. Manufacturer ID 14. Exporting Country 15. Export Date
16. I.T. No. 17. I.T. Date 18. Missing Docs 19. Foreign Port of Lading 20. U.S. Port of Unlading
21. Location of Goods/G.O. No. 22. Consignee No. 23. Importer No. 24. Reference No.
25. Ultimate Consignee Name and Address 26. Importer of Record Name and Address
Other Fee Summary for Block 39 35. Total Entered Value CBP USE ONLY TOTALS
A. LIQ CODE B. Ascertained Duty 37. Duty
$
Total Other Fees REASON CODE C. Ascertained Tax 38. Tax
$
36. DECLARATION OF IMPORTER OF RECORD (OWNER D. Ascertained Other 39. Other
OR PURCHASER) OR AUTHORIZED AGENT
I declare that I am the Importer of record and that the actual owner, E. Ascertained Total 40. Total
purchaser, or consignee for CBP purposes is as shown above, OR owner
or purchaser or agent thereof. I further declare that the merchandise was obtained pursuant to a purchase or agreement to purchase and that the
prices set forth in the invoices are true, OR was not obtained pursuant to a purchase or agreement to purchase and the statements in the invoices as
to value or price are true to the best of my knowledge and belief. I also declare that the statements in the documents herein filed fully disclose to the best
of my knowledge and belief the true prices, values, quantities, rebates, drawbacks, fees, commissions, and royalties and are true and correct, and that all
goods or services provided to the seller of the merchandise either free or at reduced cost are fully disclosed.
I will immediately furnish to the appropriate CBP officer any information showing a different statement of facts.
41. DECLARANT NAME TITLE SIGNATURE DATE
42. Broker/Filer Information (Name, address, phone number) 43. Broker/Importer File No.