24.
DUTY @ 50% ENTERED
COST IN U.S. MONEY

(incomplete)

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

A. SIGNATURE

C. DATE

D. TITLE

E. DATE

C. DATE

B. TITLE

B. TITLE

7. VOYAGE NO.

21. BOND AMOUNT

15a. Material, Etc.

22.
EXCHANGE
RATE

23.
ENTERED
U.S. COST

(full and complete)

The undeclared repairs or purchases which
I have listed on the back of this declaration.

No undeclared repairs or purchases

(mm/dd/yyyy)

(mm/dd/yyyy)

(mm/dd/yyyy)

Customs Form 226 (052196)

Form Page
1 of 2

Form Page 1 of 2

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Printing requires Adobe Acrobat Reader. Department of the Treasury, United States Customs Service

Any data typed after screen scrolls will not print.

Record of Vessel, Foreign Repair or Equipment Purchase
19 C F R 4.7,
4.14 Form Approved, O M B Number 1 5 1 5-0 0 8 2 Any data typed after screen scrolls will not print. 1. Function of this document (Mark only ONE) Cost in Foreign Money. 15. Total Amount Declared Items Below For Declaration Only, DO NOT USE FOR ENTRY 16. Certification of Master As Master of the said Vessel, I hereby subscribe to the declaration statement on the back of this document. 17. Customs Use Only. I have examined the vessel's log, which indicates: ITEMS BELOW FOR ENTRY ONLY; DO NOT USE FOR DECLARATION. CUSTOMS USE ONLY 25. Certification of Master of Authorized Agent of the Owner. I Hereby Subscribe to the statement relative to an entry on the back of this document. (Mark Box A. or Box B.) Customs Form 226 (0 5 2 1 9 6)

12.
DESCRIPTION OF WORK PERFORMED INCLUDING IDENTIFICATION OF MATERIALS/EQUIPMENT PURCHASED

11.
LOCATION (City and Country) AND DATE OF REPAIRS ETC. AND SAILING DATE FROM
THAT COUNTRY