OMB No. 1515-0093

United States Customs Service

1. IRS Identification No.

4. Name of Contact Person

2. Name of Warehouse Facility

3. Address

5. Telephone No.

BREAKAGE

QUANTITY

A.
Entry No.
and Date of
Importation

B.
Description of Merchandise

C.
Per Entry

D.
Over/Short
on Receipt

E.
Upon Receipt
Quantity

F.
In Warehouse
Quantity

G.
Beginning
Inventory
Quantity

H.
Ending
Inventory
Quantity

I.
Date Entry
Closed and
Forwarded to
Customs

BONDED WAREHOUSE PROPRIETOR'S SUBMISSION

19 CFR 19.12 (a)(5)

Any data typed after screen scrolls will not print.

(mm/dd/yyyy)

(This is a mandatory field)

(mm/dd/yyyy)

United States Customs Service. Bonded Warehouse Proprietor's Submission.
19 C F R 19.12 ( A. )(5) O M B Number 15 15-00 93 Any data typed after screen scrolls will not print. QUANTITY BREAKAGE

Customs Form 300 (04/02)

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