5. APPLICATION FOR ALLOWANCE IN DUTY BECAUSE OF:

4. DATE

3. ENTRY NO.

2. FROM: (Name and address of Importer or Agent)

1. TO: (Port Director of Customs)

DEPARTMENT OF THE TREASURY 
United States Customs Service

APPLICATION FOR ALLOWANCE IN DUTIES

19 CFR 158.11, 158.13, 158.23

OMB No. 1515-0022

(mm/dd/yyyy)

Any data typed after screen scrolls will not print.

DEPARTMENT OF THE TREASURY 

United States Customs Service APPLICATION FOR ALLOWANCE IN DUTIES
19 C F R 158.11, 158.13, 158.23 Any data typed after screen scrolls will not print. O M B Number 1 5 1 5 - 0 0 2 2 5. APPLICATION FOR ALLOWANCE IN DUTY BECAUSE OF:

Customs Form 4315 (090298)

Customs Form 43 15 (09 02 98) Form Assistant Page 1 of 6

Form Assistant
Page 1 of 6

Go to Form Assistant Page (1-6):

Nonimportation of perishable merchandise. Goods to be segregated

Excessive moisture and impurities not usually found in or upon such or similar merchandise. (Landed weight or gauge in excess of that invoiced is in itself not adequate evidence of excessive moisture or impurities.)

A.

B.

C.

Damage
Lost or stolen while in Public

Destruction (Casualty)

at our place of business
on pier