17.
HTSUS NO.

14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT?

49. DATE

48. TITLE

47. FOR THE FTZ OPERATOR (Signature)

46. To the Port Director of Customs: The above merchandise was received at the Zone on the date shown except as noted below:

45. DATE

44. CHL NO.

43. CARTMAN

42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature)

41. DATE

40. STATION

39. TITLE

38. CUSTOMS OFFICER AT STATION (Signature)

PERMIT
TO
TRANSFER

37. The goods described herein are authorized to be transferred:

36. DATE

34. PORT DIRECTOR OF CUSTOMS: BY (Signature)

The above merchandise has been granted the requested status.

33. DATE

32. TITLE

31. PORT DIRECTOR OF CUSTOMS: BY (Signature)

30. DATE

29. TITLE

28. FOR THE F.T.Z. OPERATOR (Signature)

27. DATE

26. TITLE

25. BY (Signature)

24. APPLICANT FIRM NAME

(19 CFR 146.41)

(19 CFR 146.43)

(19 CFR 146.44)

(19 CFR 146.42)

23. I hereby apply for the status designation indicated:

22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone.  I declare to the best of my knowledge and belief that the above merchandise is not  
     prohibited entry into the Foreign-Trade Zone within the meaning of section 3 of the Foreign-Trade Zones Act of 1934, as amended, and section 146.31, Customs Regulations.

11. INBOND CARRIER

12. I.T. NO. AND DATE

13. I.T. FROM (Port)

7. U.S. PORT OF UNLADING

8. FOREIGN PORT OF LADING

9. BILL OF LADING/AWB NO.

10. INWARD M'FEST NO.

3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER

5. IMPORT DATE

4. EXPORT DATE

6. ZONE ADMISSION NO.

2. PORT CODE

1. ZONE NO. AND LOCATION (Address)

OMB No. 1515-0086.

PERMIT

35. TITLE

MERCHANDISE INTO THE ZONE

FTZ
OPERATOR'S
REPORT OF
MERCHANDISE
RECEIVED AT ZONE

21. HARBOR MAINTENANCE FEE (19 CFR 24.24)

YES
NO
NONPRIVILEGED FOREIGN
PRIVILEGED FOREIGN
ZONE RESTRICTED
DOMESTIC
without exception
except as noted below

16.
DESCRIPTION OF MERCHANDISE

18.
QUANTITY
(HTSUS)

19.
GROSS
WEIGHT

APPLICATION FOR 

FOREIGN-TRADE ZONE ADMISSION AND/OR STATUS DESIGNATION

PERMIT

Permission is hereby granted to transfer the above merchandise into the Zone.

CENSUS USE ONLY

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

(This is a mandatory field)

Any data typed after screen scrolls will not print.

F.T.Z.    AGREES   TO   RECEIVE

Form Page
1 of 1

Printing requires Adobe Acrobat Reader.

DEPARTMENT OF THE TREASURY
United States Customs Service APPLICATION FOR 
FOREIGN-TRADE ZONE ADMISSION 
AND/OR STATUS DESIGNATION 19 C F R 146.32,
146.40 O M B Number 1 5 1 5-0 0 8 6. Any data typed after screen scrolls will not print. 14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT? 22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone. I declare to the best of my knowledge and belief that the above merchandise is not prohibited entry into the Foreign-Trade Zone within the meaning of section 3 23. I hereby apply for the status designation indicated: F T Z AGREES TO RECEIVE MERCHANDISE INTO THE ZONE PERMIT Permission is hereby granted to transfer the above merchandise into the Zone. PERMIT The above merchandise has been granted the requested status. 37. The goods described herein are authorized to be transferred: PERMIT TO TRANSFER F T Z OPERATOR'S REPORT OF MERCHANDISE RECEIVED AT ZONE. Form Page 1 of 1 Printing requires Adobe Acrobat Reader. of the Foreign-Trade Zones Act of 19 34, as amended, and section 146.31, Customs Regulations.

15.
NO. OF
PACKAGES
AND COUNTRY
OF ORIGIN CODE

20.
SEPARATE
VALUE & AGGR
CHGS.

Customs Form 214A (08/00)

19 CFR 146.32, 146.40

STATISTICAL COPY

STATISTICAL COPY

DEPARTMENT OF THE TREASURY

United States Customs Service