19 CFR 10.8, 10.9, 10.68,
148.1, 148.8, 148.32, 148.37

NAME, ADDRESS, AND ZIP CODE TO WHICH CERTIFIED FORM IS TO BE MAILED (If Applicable)

B/L or INSURED NO.

DATE

(NOTE:  Number of copies to be submitted varies with type of transaction.
       Inquire at Port Director's office as to number of copies required.)

NO.

Form Approved. OMB No. 1515-0042

CERTIFICATE OF REGISTRATION

DEPARTMENT OF THE TREASURY 
United States Customs Service

VIA (Carrier)

ARTICLES EXPORTED FOR:

ALTERATION*
REPAIR*
USE ABROAD
REPLACEMENT
PROCESSING*

* NOTE: The cost or value of alterations, repairs, or processing

                       abroad is subject to customs duty.

(mm/dd/yyyy)

OTHER,

(specify)

DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE CERTIFICATE OF REGISTRATION (Note: Number of copies to be submitted varies with type of transaction.  Inquire at Port Director's office as to number of copies required.) 19 C F R 10.8,
10.9,
10.68,
148.1,
148.8,
148.32,
148.37. Form Approved. O M B Number 15 15-00 42 Any Data Typed after screen scrolls will not print.

Any data typed after screen scrolls will not print.

Articles Exported For: * Note: The cost or value of alterations, repairs, or processing abroad is subject to customs duty.

Customs Form 4455 (06/00)

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