2. Nationality of ship

5. Rank or rating

4. Family name, given name

3. No.

1. Name of ship

Page No.

OMB 1515-0061

19CFR 4.7(a), 4.7a(b)

Customs Form 1304 (07/02)

8. Date and signature by master, authorized agent or officer

6.  Articles acquired abroad by officers and members of the
    crew (except those exclusively for use on voyage or
    cleared through Customs authorities)

7. No. of crewmember's

    declaration of articles

    intended to be landed

    (if none, show "NONE"

    opposite name)

CREW'S EFFECTS DECLARATION

DEPARTMENT OF THE TREASURY 
United States Customs Service

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Printing requires Adobe Acrobat Reader. Department of the Treasury
United States Customs Service. CREW'S EFFECTS DECLARATION 19 C F R 4.7 ("A"),
4.7 "A" (b) O M B Number 15 15-00 61 Any data typed after screen scrolls will not print. Customs Form 1304 (07 / 02)