-> SAC/TAMPA 121005/010

FAX
•-* -,-.•••, ••-••••- -:.\ .V;,;:;..>.-v-v.j::;-i-;:;:;v . - ' : • . • . - , ..

I ••
CUSTOMS USe ONLY *• j
WELCOME
TO THE
UNITED STATES
DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE

CUSTOMS DECLARATION
19 CFH 1Z127. IU.il. 1-W.n. WJ.lTfl, 140,111
Each arriving traveler or responsible family member must provide the
following information fonly ONE written declaration per family Is required):
1. Family Mm.

2. Finn (Glvun) Nama i Ntlal(s) 4. Birth Dale (dsy/ma/yr)

9<f ' "
S. Alrfine/Flight No. or Vssaei Nanw or Vehicle Lictmsa No. 6. Wunlxsr of Family ;::32T
Mambera Trs '
jhnVVfthYou * r~ lr.'
7. (a) Counliy 7. (b) Country oi fleaidancz

0
8. (a) U.S. Address (Start NumbeitHdeVMaiSng AOdmxfZ

a. (D) U.5. Address (XTiW

9. Countries tasted on Ms trip prior to U3. arrival

/
10. The purpose of my (our) trip la or was;
Bualneas F| Personal
(CneeKafleorbomoa"*,!" " "' t ":^ .°J -'VL'"^''^'^'!;!-':-;-'
11.1 am (We are) bnnging truits, planffl, rficsls. Wot
soil, birds, snails, other live animaJs, wj/cflil
products, farm predijcte or, have bean on aOim t
ranch outtttatfieUS.: / ^
.1 am (W« are) carrying currency op^f
jnatrumerc gvw $10,000 U.S., or
Yea No

13.1 Have (We havo) commercial merchAxfise, U.S.

of foralgn: fC/w* one tax onfi^ 1 No

14. The total value o) al) gooda. Including -,.

cial merchandise, I/we purchased or acqL
abroad and am/ara bflngjnr; lo me U.S. u: ., . ..--. -
(See fte JnsOUCfrans on Ihfl 6a<* of Ihts form undafJMErtCHANDrSE' and use the space
provided ttieft toSstaltftt items you must daoa/t. If you have nothing to declare, write '-O-'
in the space ptuvklsa above).

SIGN ON REVERSE
|;:4^- ;:••?•!'. -;fe.;^4E^K ^
f:::h-: .•; j-^- ";•-;,.;•: ,;• : • •
I have read the notice onjhe reverse |J aCffgtriful dedaration.

U.S. C"stpjia.uae only- QofrdLvirfite b»low this Una - U.3. Custarns Use only
STAMP AREA

TIMI
^SZZ
Customs Form S059B (101B95)
 SAC/TAMPA E1006/010
02/21/2002 11:26 FAX

r
NOTICE

Th» urtiMtM Impwttiton af cortrpOed sutetarew (nansfifaa, ctiembob. prereripdon medfclmss »

na« aeeompanJed by A prwcnpdon, ot) regaHtaa. of amount bj a vtolaUon nf US. tew.

To pomr* Iha artiro* cBngafous agricultural pass and (VoWhteO w»2Sg,tfiBto«owr«ia

ad: fiUfc. vvgetaoW ptants, plaiZpradgca. aot, moats, meat produce, Mnfc, snafe. and otter
to aittnate or animal poxfaos, wfctoa and wtdlM pftrtetH. FaOtao to dadam al such toma to a
Qoonu/Aflrtaaural/VflldBe nffinw can mautt h penBflfes and me tans may ba*jbJB<* to seizure.

Tna bansporiaion of eunsrey or manataiy ndiunanla,,REGAHOIBS OF AMOUNT 13 LEGAL;

ifyoB take 01* of offering Into tta Uroad SIMMroom«wn HO.OOOGJ.B-artoio
aveiTifyoB
alant, or a cemWnadan of 9vj two) In coin, oinency. iKjvstert cfieokxarbaaierlietunaitiaijAa
money onlors, peraonal ar eashtaw ehacta, stocks ortapnda.yow are atftrai BY1 LW to FILE a
icport on Forni 4780 win BIB U.S. Customs Qgntoa. K you hat* sornaona aho cany na curoney
or irobunientt far yoi. you mua also Be *•report.fmUBE TO I=1L£ THE HHJWRED REPORT
OB FAUIftE TO REPORT THE TQBL AMOUNT YOU ARE CAHHYINa VIAY LEAD TO THE
SEELIHE OF flU. TH5 CURRB4CY OR INSTRUMENTS, AND MAY SUBJECT YOU TO CIVIL

MERCHANDISE
MSrrcvtS <NOt*£t£3IDEMTS) mual dectara h Ham 14 *« total vakio or aB aidcfe* WencW bf
ohsre and al Iwne Intenobd » be tola or toft ki Iho U.a Tnta Indudae all flite and omnantel
Horns orsamptoi. (EXCSHlOfc Vtwomr pureonaloflocw, so* as doffihg. pmonaljewdiyand
eamora aqulpnen, lugoapa. ota. need net be Declared.)
U£ RESDSNrs mat aactaa h »em u *•• Mai vahia or ALL aiactaa. ddudkig commardal
goods and samptee. fay acqufced abroad (wlwhw new or used; dufiabfe or not ana whslnar ot»
teJTefl ty purdBae. nomad as fl 98. or omaftriaj), Induing iheaa arihka purettaani In DUTY
FREE STOBES IN THE UA OR ABROAD, whfch aro fn tnar paamHan at »» dim ol antar. Ar-
lidos vfrtcn ytw acquired en Hs kip naiad from «Dnod, (etnar lhan artdaft acquired m Jreutar
poaasuions and various Caribbean Bosh «urtH«*) are duifawe upon ihqirarrtvflJ intfwU.a

r
7JCM*3LWrC^DaTyTDaentlD^b«dalBiw(r«dbyaCX«g^
nomxjy anttled ID a *xy fns Exsmpdon of J4oo on txm terns amanpanying tfwnv noo-nsii-
darts am normally ontMad lo an aernpllan at Sva. Duty Is normally « >at raB ol 10% on Ihe first
ilOOO abova axanVfan. 0 ha vakia ar good; dadamd In Item U EXCffiDS $i4co PEF1
PERSON, lhan tel Aa artctas b«l™ and ahow price paid h US dUffinc or, far ante, bir ratal vah
««. Pteaaa describe al artfctas by Ifieir common naroag and nakatal. Fof axanpla: MAtfS WOOL
KNtT SWEATER; DIAMOND AND t3CXD RIN3; ate. Also, piease ha« al your mcslpls ready lo
pieMnt tu the Qwoms oftcar. a requested Tnta wH holp to fecWaia [he Inspedfan procasa.
COMMEftoMt MERCHANDISE can Be dnonwd as anfclw for fitto, far sOWBr^ oretera. a- otfxr
gooefe not consi*5n=d pononal alfcos o» Vn Budar.
IF YOU HAVE ANY QUESTIONS ABOUT WHAT MUST BE
REPORTED OR DECLARED ASK A CUSTOMS OFFICER
DESCRIPTION OF MH 1 ICCES VALU£ CUSTOMS USE
(Ltiq rn& be txnttnyed on anoffwf Fern BOSOty

vN
X^ Ci

*; feirh-U, :''"•!:-' -.-f1.".

i ^
TOTAL|>
; Raouun AO Nococ Tn« rjbnmikxt cwdpdna on nb Mm to n*»M k> oury out mo cuBunu, Ao-
WJlBW, and SWWHqr bM o( Jm Unlod StcM. W« ru*d Itolr»ux Ihal tmyohm »» canply^ >*hTOMB«S
and O aB«i» us bflguraant oAo lh» ligtt omxrt o( <MC «J BOM. Mbgf raepma U mnUur.
Tte itfanaM ivnraflo burtwi aoarbied nth Mi eotoctai e( hfetmooiti K 3 rtAmia) p«r raspgndn or m-
«r*o«3or rHamvJIfia on nniMud anmo&toa. Cotmona eenesmfng no aosaraw m I* bunion BsamoiB
nnfl msntfcm lor OKfudnu MB twotan rfiould bo dkso«rf in UA Omorm &n*«, Po»mo* Mai»B«monl
Branai. wa»Hnjtm DC anaaa. PO Aormnn guiy^jBdiagmti n tnii OK*.
.-.- ..:..rl TJJK3JX3nBB7-«34-«jc Cuatan Form 30388 (lOiagSKBndc)
 02/21/2002 11:26 FAX -» SAC/TAMPA 12)007/010

MINISTERE DES FINANCES OMB No. 1506-0014

SERVICE DE LA DOUANE DES ETATS-UNIS
Ca formulairo doit At/a remis au
Serrici da la douane das Etats-UnK
DECLARATION DE TRANSPORT
31 U.S.C. 531 8: 31 CFR 10323 ol 103.27 *• Avis relatif 4 la lol sur HnvlolabllW du
INTERNATIONAL DE MONNAIE ««cr«l <t« la vl« prlvA» (volr las
Rampltf ilamadthcifarccutairecncaracuifvscnniprlniefle. OU D'INSTRUMENTS MONETAIRES instructions au varan)
^y,R,^S™E^9^ES,ENTRANT ^ SORTANT OES ETAT-UNIS. OU LES PERSONNES EXPEDlANT OU ENVOYANT PAS IAPOSTE OU R5CEVANT UNE
MONNAIE OU TOUTAUTRgJNSTRUMEMT MONETAIRE (51 AGISANTAU NOM Dg QUELQLTUN D'AUTRE. COMPLETEZAUSSI LA II 6me PARTIE CK>E5SOUS)
1. NOM: (mm da faipille, pranom at dauxfems pe&iom) 2, NUMERO D'IDENTIFICATION (volr InanJCSon) 3. DATE DE NAISSANC5 Imait.jmf. aiwitol
tf~ /7&?&?*y
4. DOMIC ETATS-UlUlSXIU A L'ETRAN6ER 5. NATIONALFTE Ou PAYS DE
NATIONALTrE

6. ADRESSE PENDANT VOTRE SEJOURAUX ETATS-UNIS 7. NUMERO DU PASSPORT £T PAYS

tf.f**
B. DATE DU VISA DELIVRE PAR U£S 9. LJEU DE DELlVRANCE DU VISA DES ETATS-UNIS 10. NO D'ETRANGER IMMIGRANT

11. 31 LA MONNAIE OU D£ UNSTRUMENT MONeTAITE EST ACCOMPAGNE PAR LA PERSQNNE. COMPLETE2 11(8) 00 (b)
A. EXPORTS DES ETATS-UNIS B. IMPORT* OES ETATS-UNIS
Depart da: (port ou viile das &ais-Unl&) Arrivie S: {viUelpays atrang/tf Afrivie i (vine des £l*tS-Unis)

?** /
12. 51 LA MONNAIE OU L1NSTRUMENT MONETAIRE EST ACCOMPAGNE PAR LA PERSONNE, COMPLETEZ 12a OU 12b
12a. DATE DE L'ENVOI 12h. DATE DE RSCEPTION 12c, METHODE DE TRASNPORT OWMOTWKI 12d. NOM DU TRANSPOKTEUR

12s. ENVOYS A (nont a! adftssef

r ^tECU DE (notn et adrasse)

It erne PARTIE INFORMATION CONCERNANT LA PERSONNE(S) OU LA COMPAGNIE AU NOM DE LAOUELLE L'lMPORTATION OU L'EXPQRTATlON A ETC FAITE ,
13. NOM frtom d»fom/Y/e,pro/7o/n, ou dauxiame prenom ou la ftom de la compegnla)

14. AQRESSE PERMANENTE AUX ETATS-UNIS ET A LtiTRANGER.

15. TYPE DE LA COMPAGNIE, OCCUPATION OU PROFESSION 1Sa. EST-CE OU'UNE BANQUE?

D OOl D NON
ill erne PARTIE INFORMATION SUR LA MONI>lAIE ET L' INSTRUMENT MONETAIRE (VOIR INSTRUCTION AU VERSO) (dolt Sire corrvlStaa par tous tes Interessts)
16. TYPE ET COMPTE DE LA MONNAIE ET INSTRUMENT MONETAlRg 17. SI TOUTE AUTRE MONNAIE OXI5
VajlLLEZREMPURLAUGNEAETB O
Places et monnaics n >•
*^?,?<?P ^ A, Nom de la monrraic

Auire Instrumenl momitaira (Sp6riR6 te type. D >•

''sot/14 jfflettrfce ou autra numiro d'idantificatlon) 5 /?^fcr* /^^
B. Pays
(TOTAL! a >•
*/?%? &*<> ^
IV erne PARTIE SIGNATURE OE LA PSRSONNE QUIA COMPLETE CETTE DECLARATION

Sous pelne de parjure, je declare avoir lu la presents declaration et, en toute connaissanca de cause la declare veridique. exacte et
complete.
1B. NOM at T1TRE (fcrtre en letUs d'imptjmerie)
imprj 19. SIGNATURTE 20. DATE DE LA DECLARATION

—- . COMPTE VERIFY agSlJSRATION

Pk RESERVE AU SERVICE DE LA DOUANE SEULEMENT ^~\E
r ^ X^Oul / Non / Oui / Non
COMPAGNIE AERIENNE. VOLS/NAVIRE PLAQUE 0'IMMATRICULATION [^_ JWSPECTEUR (notneLo«fh««> W °ao9c)
ETAT/ PAYS NUMERO
-~<?^^/ ^-^? ^-^> ^^^^^ ^Z?sZ? "^ ^^

CUSTOMS FORM 4790 (04/00) (French)