United States Customs Service

OMB No. 1515-0050

DECLARATION OF OWNER

FOR MERCHANDISE OBTAINED (OTHERWISE THAN) IN PURSUANCE OF A PURCHASE OR AGREEMENT TO PURCHASE

This declaration must be presented at the port of entry within 90 days after the date of entry in order to comply with Section 485(d), of the Tariff Act of 1930. LINE OUT EACH PHRASE SHOWN IN ITALICS NOT APPLICABLE TO THIS DECLARATION.

1. NAME OF OWNER

3. SUPERSEDING BOND SURETY CODE

4. PORT OF ENTRY

5. PORT CODE

7. VESSEL/CARRIER ARRIVED FROM

6. IMPORTER NUMBER OF AUTHORIZED AGENT 

   (SHOW HYPHENS)

10. DATE OF ENTRY

9. ENTRY NUMBER

11. DATE OF ARRIVAL

8. IMPORTER NUMBER OF OWNER 

   (SHOW HYPHENS)

19 CFR 24.11(a)(1), 141.20

Any data typed after screen scrolls will not print.

(mm/dd/yyyy)

(mm/dd/yyyy)

(This is a mandatory field)

United States Customs Service Declaration of Owner, For Merchandise Obtained (Otherwise than) in Pursuance of A. Purchase or Agreement to Purchase.
19 C F R 24.11 ( A. )(1), 141.20 O M B Number 15 15-00 5 0 Any data typed after screen scrolls will not print. This declaration must be presented at the port of entry within 90 days after the date of entry in order to comply with Section 4 8 5 (d), of the Tariff Act of 19 30. LINE OUT EACH PHRASE SHOWN IN ITALICS NOT APPLICABLE TO THIS DECLARATION.

Customs Form 3347 (12/02)

Customs Form 33 47 (12/02) Form Assistant Page 1 of 3

Form Assistant
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2. ADDRESS OF OWNER (STREET, CITY, STATE, ZIP CODE)