Form approved
O.M.B. No. 1515-0051

ENTRY AND MANIFEST OF MERCHANDISE FREE OF DUTY, CARRIER'S CERTIFICATE AND RELEASE

1. NO.

19 U.S.C. 1433, 1484, 1498; 19 CFR 123.4, 143.23

The undersigned, as the importer of merchandise described below, which arrived at the port or station identified, hereby claims free entry therefore under the provisions of the applicable law indicated.

2. PORT CODE

3. DATE

4. VESSEL OR OTHER CONVEYANCE

5. ARRIVAL DATE

6. COUNTRY OF EXPORTATION

DEPARTMENT OF THE TREASURY 
United States Customs Service

(mm/dd/yyyy)

(mm/dd/yyyy)

DEPARTMENT OF THE TREASURY
United States Customs Service Entry and Manifest of Merchandise Free of Duty, Carrier's Certificate and Release.
19 U S C 1433,
1484,
1498;
19 C F R 123.4,
143.23 Form Approved O M B Number 15 15-00 51. The undersigned, as the importer of merchandise described below, which arrived at the port or station identified, hereby claims free entry therefor under the provisions of the applicable law indicated.

Customs Form 7523 (052496)

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