Department of the Treasury
United States Customs Service Report of Diversion
19 C F R 4.91 ("A") and (b) O M B Number 1 5 1 5 - 0 0 7 1 Any Data typed after screen scrolls will not print. Form Assistant Page 1 of 3

DEPARTMENT OF THE TREASURY

UNITED STATES CUSTOMS SERVICE

OMB No. 1515-0071

REPORT OF DIVERSION

2. NATIONALITY (American or Foreign)

1. PORT WHICH GRANTED CLEARANCE OR PERMIT TO PROCEED

5. DATE

4. RIG

3. NAME OF VESSEL

CUSTOMS PORT DIRECTOR

19 CFR 4.91 (a) and (b)

(MM/DD/YYYY)

(This is a mandatory field)

Any data typed after screen scrolls will not print.

Customs Form 26 (03/00)

Customs Form 26 (03 / 00)

Form Assistant
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