24. DUTY @ 50% ENTERED COST IN U.S. MONEY
DEPARTMENT OF THE TREASURY United States Customs Service
Form Approved, OMB No 1515-0082
1. FUNCTION OF THIS DOCUMENT (Mark only one)
ITEMS BELOW FOR ENTRY ONLY; DO NOT USE FOR DECLARATION
18. ENTRY NUMBER AND DATE
DECLARATION
RECORD OF VESSEL FOREIGN REPAIR OR EQUIPMENT PURCHASE
(Complete Items 1 through 16 Only)
ENTRY
(Complete Items 1- 15 and 19-25)
19 CFR 4.7, 4.14
2. OWNER NAME AND ADDRESS
19. NAME OF PRINCIPAL AND SURETY
3. REPRESENTED LOCALLY BY
5. NAME OF MASTER
4. VESSEL NAME
6. PORT ARRIVED FROM
10. ARRIVAL DATE
20. BOND NUMBER
9. PORT CODE
8. U.S. PORT OF ARRIVAL
COST IN FOREIGN MONEY
13. Material, Parts or Equipment
14. Labor
15b. Labor
15. TOTAL AMOUNT DECLARED
ITEMS BELOW FOR DECLARATION ONLY, DO NOT USE FOR ENTRY
25. CERTIFICATION OF MASTER OR AUTHORIZED AGENT OF THE OWNER
16. CERTIFICATION OF MASTER
17. CUSTOMS USE ONLY
AS MASTER OF THE SAID VESSEL, I HEREBY SUBSCRIBE TO THE DECLARATION STATEMENT ON THE BACK OF THIS DOCUMENT.
I have examined the vessel's log, which indicates:
I HEREBY SUBSCRIBE TO THE STATEMENT RELATIVE TO AN ENTRY ON THE BACK OF THIS DOCUMENT.
(Mark Box ''A" or Box ''B')
A
B
C. SIGNATURE
A. SIGNATURE
C. DATE
D. TITLE
E. DATE
B. TITLE
7. VOYAGE NO.
21. BOND AMOUNT
15a. Material, Etc.
22. EXCHANGE RATE
23. ENTERED U.S. COST
The undeclared repairs or purchases which I have listed on the back of this declaration.
No undeclared repairs or purchases
(mm/dd/yyyy)
Customs Form 226 (052196)
Form Page 1 of 2
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12.DESCRIPTION OF WORK PERFORMED INCLUDING IDENTIFICATION OF MATERIALS/EQUIPMENT PURCHASED
11.LOCATION (City and Country) AND DATE OF REPAIRS ETC. AND SAILING DATE FROMTHAT COUNTRY