Signature of Customs Officer
Form Approved OMB No. 1515-0013
APPLICATION-PERMIT-SPECIAL LICENSE UNLADING-LADING-OVERTIME SERVICES
United States Customs Service
8. Locations (Dock/Terminal)*
4. Name and Nationality of Owner/Operator
1. Name of Vessel, Vehicle or Aircraft
19 CFR 4.10, 4.30, 4.37, 4.39, 4.91, 10.60, 24.16, 122.29, 122.38, 123.8, 146.32, 146.34
6. Arriving from
(Port Name and Country)
Customs Form 3171 (01/02)
Form Assistant
Page 1 of 5
Go to Form Assistant Page (1-5):
5. Name/Phone No. of Agent
(country code, if applicable for both)