4.  Identifying Number on Original Report

5.  Reporting Period of Original Report

Year

(One Quarter Only)

6.    Reason for Amended Report

A.

B.

C.

(1)

(1)

(2)

(2)

(3)

(3)

(4)

(4)

(5)

(5)

OMB No. 1515-0158. For Paper Reduction Notice see Customs Form 349.

1.  Identifying Number

2.  Name of Company or Individual

DEPARTMENT OF THE TREASURY 

United States Customs Service

HARBOR MAINTENANCE FEE
AMENDED QUARTERLY SUMMARY REPORT

3. Complete Mailing Address

19 CFR 24.24

(This is a mandatory field)

1
2
3
4
Calculation/Clerical Error
Duplication of Payment
Misinterpretation of Exemptions
Overvaluation of Shipments
Other (Please Specify)
Request for a Refund, because:
Correction of Items 1-4
Calculation/Clerical Error
Omission of Shipments
Misinterpretation of Exemptions
Overvaluation of Shipments
Other (Please Specify)
Remit a Supplement Payment, because:
O M B Number 1 5 1 5-0 1 5 8. For Paper Reduction Notice see Customs Form 3 4 9. DEPARTMENT OF THE TREASURY 
United States Customs Service HARBOR MAINTENANCE FEE
AMENDED QUARTERLY SUMMARY REPORT
19 C F R 24.24 4.  Identifying Number on Original Report 5.  Reporting Period of Original Report 6.  Reason for Amended Report. 1.  Identifying Number.

Customs Form 350 (06/02)

Customs Form 350 (06/02)

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EIN or IRS
Customs
SSN

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EIN or IRS
Customs
SSN