OMB 1515-0213

Certificate of Delivery

1. CM&D No.

2. Port

    Code

3. DBK Ruling No.

DELIVERY CERTIFICATE FOR PURPOSES OF DRAWBACK 

Certificate 

of Manufacture and 

Delivery

4. Type

     Code

5. ID No. of Transferor

RECEIVED DATE

7. TO TRANSFEREE:

6. FROM TRANSFEROR: 

Company Name

Complete Address

DEPARTMENT OF THE TREASURY 
United States Customs Service

19 CFR 191

Company Name and Complete Address

(mm/dd/yyyy)

DEPARTMENT OF THE TREASURY
United States Customs Service Delivery Certificate for Purposes of Drawback
19 C F R 191 O M B Number 15 15-0 2 1 3 6. FROM TRANSFEROR: 7. TO TRANSFEREE:

Any data typed after screen scrolls will not print.

Any data typed after screen scrolls will not print.

Customs Form 7552 (08/01)

Customs Form 7 5 5 2 (08/01) Form Assistant Page 1 of 4

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