Cbp Form 3299 - Declaration Of Free Entry Of Unaccompanied Articles Page 2

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D. LIST OF ARTICLES

(3) VALUE OF

(4) FOREIGN MERCHANDISE TAKEN ABROAD THIS

(1) ITEM NUMBER

(2) DESCRIPTION OF MERCHANDISE

COST OF

TRIP: State where in the U.S. the foreign merchandise

CHECKED IN PART

REPAIRS

was acquired or when and where it was previously

IV, A., B., C.

declared to CBP.

PART V -- CARRIER'S CERTIFICATE AND RELEASE ORDER

The undersigned carrier, to whom of upon whose order the articles described in PART I, 8., must be released, hereby certifies that the person named in Part I,

1., is the owner or consignee of such articles within the purview of section 484(h), Tariff Act of 1930.

In accordance with provisions of section 484(h), Tariff Act of 1930, authority is hereby given to release the articles to such consignee.

1. NAME OF CARRIER

2. SIGNATURE OF AGENT (Print and sign)

Date

PART VI -- CERTIFICATION TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY

I, the undersigned, certify that this declaration is correct and complete.

1. "X" One

A. Authorized Agent* (From facts obtained from the importer)

B. Importer

2. SIGNATURE

3. DATE

*An Authorized Agent is defined as a person who has actual knowledge of the facts and who is specifically empowered under a power of attorney to execute this

declaration (see 19 CFR 141.19, 141.32, 141.33).

2. DATE

1. SIGNATURE OF CBP OFFICIAL

PART VII -- CBP USE ONLY

(Inspected and Released)

CBP Form 3299 (07/16)