Certificate Of Registration For Personal Effects Taken Abroad

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OMB No. 1651-0010; Exp. 08-31-2012
Number
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
CERTIFICATE OF REGISTRATION
FOR PERSONAL EFFECTS TAKEN ABROAD
19 CFR 148.1
Name of Owner
Address of Owner
Description of Articles
Signature of Owner
I certify that the information shown hereon is
true and correct to the best of my knowledge
and belief.
Port
Date
Signature of CBP Official
Certifying officer shall draw lines through all unused spaces with ink.
CBP Form 4457 (08/09)

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