OMB 1515-0213

5. Drawback Center

3. Intended Action 

2. Drawback Entry No.

4. Intended Date of

    Action 

1. Exporter or Destroyer

Name

Destroy

Export

DATE RECEIVED

Address

6. Contact Name

Address

Ext.

Phone 

I.D. Number

FAX 

Any data typed after screen scrolls will not print.

(This is a mandatory field)

(mm/dd/yyyy)

(mm/dd/yyyy)

DEPARTMENT OF THE TREASURY 
United States Customs Service NOTICE OF INTENT TO EXPORT, DESTROY OR RETURN MERCHANDISE FOR PURPOSES OF DRAWBACK
19 C F R 191 Any data typed after screen scrolls will not print. O M B 15 15-0 2 1 3 3. Intended Action 1. Exporter or Destroyer

Customs Form 7553 (08/01)

Customs Form 7 5 5 3 (08/01)

DEPARTMENT OF THE TREASURY 
United States Customs Service

19 CFR 191

NOTICE OF INTENT TO EXPORT, DESTROY OR RETURN MERCHANDISE FOR PURPOSES OF DRAWBACK

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