ya Do a Te eat ete) Customs Declaration cane: S8FR 227, 12, 3 eB. 1, CRI ub 83003 eeepuentay ONE micatusciatte comme’ ee 1. Family Name Fire Given Midae 2. Birth date Day Month Year 3. Number of Family members traveling with you 4. (US. Seret Address (hotel name/estnation) () City (State 5. Passport issued by (country) 6. Passport number 7. Country of Residence 8. Countries visited on this trp prior to US, arrival 9. Airline/Flight No. oF Vessel Name 10. The primary purpose ofthis trips business: Ye No 1, Tam QWe ate binging 6) fruits, vegetables, plans, seeds, food, inser: Yes No (©) meats, animals, animal/widife products: Yer No (© disease agents, cell ealtures, snails Yes No @ soil or ave been on a farm/ranch/pastur: Yes No! 12.1 have (We have) been in close proximity of (ouch as touching or handling) livestock: Yes No 13. Tam (Weare) carrying eurrency oF monetary instruments over $10,000 U'S. or foreign equivalent: Yes. No (Gee definition of monetary instruments on reverse) |4.Thave (We have) commereial merchandise: Yes No (articles forsale, samples used for soliciting orders, ‘or goods that are not considered personal effects) 15.Residents — the total value of all goods, including commer ‘merchandise L/we bave purchased or acquired abroad, (including gifts foe someone else, but not items mailed to the U.S.) and anv/are bringing tothe US. is $ Visitors — the total value of all articles that will remain in the US. including commercial merchandise i: $s Read the instrucsions on the back of this form. Space is provided to lst all the items you must declare. HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION. For Offical Use Only (08° Fox 60508 (01/04)U.S. Customs and Border Protection Welcomes You to the United States q ‘USS. Customs and Bonder Protection is responsible for protecting the United States againt the ill importation of profited tems. CBP officers have the authority to question you and to examine you and your personal property f youare one of the travelers sclcted for an examination, you will be trexed ina ‘courteous, profesional, snd dignified manner. CBP Supervisors and Passenger Service Representatives are valable to answer your questions. Cent ead ate available vo compliment or provide feedback. Important Information US. Residents — decir all articles that you have acquired abroad and are bringing into the United States Visitors (Non-Residents) — declare the value ofl aries tha wil remain inthe United Sates. ‘Declareall articles on this declaration form and show the valuein US, dollars For gifts, pleas indiate the etal value. ‘Duty — CBP ofcers wil determine du: US. residents ae normaly entitled to a duty-free exemption of S800 on items accompanying them. Visitors (m- resident) are normally entitled wo an exemption of $100 Duty wil be asesed ar the curren rate onthe fst ,000 shore the ekemption. Controlled substances, obscenc articles, and toxic substances are generally prohibited entry. Agriculture products are restricted entry. ‘SAMPLE ‘Thank an, end Welame to the United State The DARI E (COWL, ox monctary tnsrumenss, repiilas of the amount, is legal. However, if you bringin to of take out of the United States ‘more than $10,000 (U.S. ot foreign equivalent, or a combination of both), you are Feared by Taw to fle a repore on FinCEN 105 (formerly Customs Foert 4790) ‘with US. Cusoms and Border Protection. Monetary instruments include coin, "urrency, travelers check and bearer instraments sich a personal or cshirs checks tnd stocks snd bonds. Ifyou have someone else catry the currency oF monetary ‘nsrument for you, you mst also fea report on FRCEN 108, Fare co fle he required report or filure wo report dhe tal amount that you ate carrying may Teal to the seizure of all the curency or monetary instrument, and may subject you to {ul penalties and/or criminal prosecution. SIGN ON THE OPPOSITE SIDE OF FORM AFTER YOU HAVE READ THE IMPORTANT INFORMATION ABOVE AND MADE A‘TRUTHEUL DECLARATION. Description of Articles cep (Uist my continue on anther CBP Form 50508) Value Use Only Total [BYERRORRENCTENICTHOTE Papen pe at ct an, foemut ort nner stright scat bn eben, ‘ocr ane Sane CP aaa nema ha ee ‘Sinesiee dh detent brgtanomtan wate rps sun many ‘Sauce vines ie peon name ots aaeen tent wat cgae a AB oe ‘frog mene tcc tskume ces ‘an ronan sca he conan aye ea ‘erent 00S Gums as htc es Ger Dar amr ees ary Resege Be iar hov ee RonooceomouTarmRonL ror ecorrowsMuecR Us 60: 200 7esa79eN20 ‘GBP Form 60598 01/04)