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Sample Us Customs Declaration Form 6059b PDF
Sample Us Customs Declaration Form 6059b PDF
IMMIHELP.COM
CustomsDeclaration
FORMAPPROVED
Oil,lB
NO.1651-0009
Each arriving traveler or responsiblefamily member must provide the following
information (only ONE wriften declaration per family is required):
1. FamilyName
19CFR122.27,148.12,
148.13,
148.110,148.111,
14S8i
31CFR5316
Ftlr.;t (Giorn)
2. Birdr date
Middle
D^y
Month
Year
(b) City
(c) State
Yes
No
Yes
No
Yes
No
Yes
No
C B P F o r m6 0 5 9 8 ( 0 1 / 0 4 )
U.S.Customsand BorderProtection
WelcomesYou to the UnitedStates
U.S. Customs and Border Protection is responsible for protecdng the United
Statesagainstthe illegal importation of prohibited items. CBP officers have the
authority to question you and to examine you and your personal properry. If
you are one ofthe travelersselectedfor an examinarion,you will be treated in a
courteous, professional,and dignified manner. CBP Supervisorsand Passenger
ServiceRepresentativesare availableto answeryour questions.Comment cards
are availableto compliment or provide feedback.
lmpoitant Information
U.S. Residents - declare all articles tiat you have acquired abroad and are
bringing into the United States.
Visitors (Non-Residents) - declare the value of all articles that will remain
in the United States.
Declare all articles on this declaration form and show the value in U.S. dollars.
For gifis, pleaseindicate the retail value.
D.tty - CBP officers will determine duty. U.S. residentsare normally entitled
to a duty-free exemption of $800 on items accompanyingthem. Visitors (nonresidents)are normally entided to an exemption of $100. Dury witl be assessed
at the current rate on the first $1,000 abovethe exemption.
Controlled substances, obscene articles, and toxic substances are
generally prohibited entfy. Agriculture products are reefficted entry.
Thank You,anil Vlhlccmeto tbe IJniteil Statet.
SAMPLE
IMMIHELP.COM
Descriptionof Articles
ValUe
CBP
tlse Only
Total
PAPERWORK
REDUCTION
ACf NOTICE:
Th6 Paperuod(
Aclsaysw musttellyouwhywearemllectingthlsintomation,
Reduclion
t|o\irlvewill useit, andwhethsyouhaveto givil to us.Theinformation
colleciedon thisfom is neededto crryouttheCustoms,
Agticulhire,
ad urency lawsof theUnihdStales.CBPrequirestheinfornationon lfiis formto in6urethattravelersaremmplying
wih ts hs andio allowusto figureandmllectlhefightamountof dutyandtax.Yourresponse
is mandatoryAnagenclmaynot
$rduct s sponw, anda poFonis rct requiFdto 6pond to a collclion
of infomation,
unlessit displays
a validoMB6ntml number
perrespondent
TheestimaHavemgeburdona$miatedwithlhismllectonof infomationis4 minutes
or recodkeeperdepending
on
individulcirdmstances.
Commnts
theamumcyof $is burdenestimate
conceming
andsuggesllons
forrcducing
thisburdenshould
be directed
to U.S.CustonsandBordsrPrdtection,
Seryices
Dc
ReponsClearanm
offmr, lnfomation
Branch,
Washing'ton,
20229,andto theOffceofManagemont
Project(1651.0009),
andBudget,PapeMo*Reducdon
Washington,
DC20503.THISFORM
I{AYNOTgE REPRODUCED
WTHOUTAPPROVAT
FROI,ITHECBPFORMSMAI'IAGER
'u.S. G.Po.:2005 - 783-076/80026
CBP Form 60598 (01/04)