Sample US Customs Form - Form 6059B for US Customs and Border

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Sample US Customs Form - Form 6059B for US Customs and Border Powered By Docstoc
					                                                    SAMPLE
                                                 IMMIHELP.COM
CustomsDeclaration                                             FORMAPPROVED
19CFR 22.27,
     1     148.12,
                148.13,
                     148.110,148.111,31CFR 6
                                14S8i     531                      NO.
                                                              Oil,lB 1651-0009
Each arriving traveler or responsiblefamily member must provide the following
information (only ONE wriften declaration per family is required):
1. FamilyName
    Ftlr.;t (Giorn)                                        Middle
2. Birdr date            D^y       Month                 Year
3. Number of Family members traveling with you
4. (a) U.S. Street Address (hotel name/destination)


   (b) City                                               (c) State

5. Passport issued by (country)
6. Passport number
7. Country of Residence

8. Countries visited on this
   rip prior to U.S. arrival
9. Airline/Flight No. or Vessel Name
10. The primary purposeof this trip is business:                   Yes            No
I l. I am (We are) bringing
     (a) fruits, vegetables,
                           plants, seeds,
                                        food, insects:            Yes             No
    (b) meats,animals,animaVwildlife products:                     Yes            No
    (c) diseaseagents,cell cultures, snails:                       Yes            No
     (d) soil or have been on a fann/rancVpasture:          Yes        No
12.I have QV'ehave)been in close proximity of
     (such as touching or handling) livestock:              Yes        No
I 3. I am (We are) carrying currency or monetary
     instruments over $10,000 U.S. or foreign equivalent    Yes        No
     (seedefinition of monetary instrurnentson reverse)
14.I have (We have)commercial merchandise:                  Yes        No
     (articlesfor sale,samplesused for soliciting orders,
     or goods that are not consideredperconaleffects)
l5.Residents - the total value of all goods, including commercial
     merchandise I/we have purchased or acquired abroad, (including gifts
     for someoneelse,but not items mailed to the U.S.) and amlare bringing
     to the U.S. is:                                      $
     Visitors - the total value of all articles that will remain in the U.S..
     including commercial merchandiseis:                  $
Read the instructions on the back of this form. Soaceis nrovided to list all the
items you must declare.
I HAVE READ THE IMPORTANT                           ON
                                    INFORMATION THE REVERSESIDE OF
THI$ FORM AND HAVE MADE A TRUTHFULDECLARATION.




For Official Use Onll'


                                                            C B P F o r m6 0 5 9 8 ( 0 1 / 0 4 )
                      U.S.Customsand BorderProtection
                      Welcomes You 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
ServiceRepresentatives availableto answeryour questions.Comment cards
                         are
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 (non-
residents)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.
            SAMPLE                    Thank You,anil Vlhlccme tbe IJniteil Statet.
                                                             to
         IMMIHELP.COM
The transportation of currency or monetary instruments, regardless of the
amount, is legal. However, if you bring in to or take out of tle United States
more than $10,000(U.S. or foreign equivalent, a combinationof both), you are
                                                  or
required by law to file a report on FinCEN 105 (formerly CustomsForm 4790)
with U.S. Customs and Border Protection. Monetary instruments include coin.
currency,  travelerscheck and bearerinstruments    suchaspersonal cashiers
                                                                   or        checks
and stocksand bonds. If you have someoneelse carry the currency or monetary
instrument for vou. vou must alsofile a reDort on FinCEN 105. Faiiure to file th!
requ.ired report or ir'il*" to report the tut;l amotrrft
                                                       that you.arecarrying may lead
to ttre seizureof all the currencyor monetaryinstruments,and may subjectyou to
civil penaltiesand/or criminal prosecution.   SIGN ON THE OPPOSffE SIDE OF
THIS FORA4AFTER YOU TIA\,'E READ THE IIVTPORTI{NT INFOR.N,IAIION
ABOVE AND MADE A TRUTHFI]L DECLAMTION.
Description Articles
           of                                                                                   CBP
(List may contlnue on another CBP Form 60598)                           ValUe                tlse Only




                                                          Total
PAPERWORK     REDUCTION NOTICE: Paperuod(
                          ACf        Th6          Reduclion says must youwhywearemllecting intomation,
                                                           Acl     w       tell                       thls
t|o\ir will useit, andwhethsyouhave giv€il to us.Theinformation
     lve                            to                                  on
                                                               collecied thisfom is needed c€rryouttheCustoms,
                                                                                              to
           ad
Agticulhire, urency lawsof theUnihdStales.              the           on
                                             CBPrequires infornation lfiis formto in6ure travelers mmplying
                                                                                            that        are
wih t€s hs andio allowusto figure mllectlhefightamount dutyandtax.Your
                                  and                     of                          is
                                                                             response mandatory- agenclmaynot
                                                                                                   An
$rduct s sponw, anda poFonis rct requiFd 6pond to a coll€clion infomation,
                                        to                   of                  it
                                                                           unless displays validoMB6ntml number
                                                                                            a
TheestimaHavemge      burdon                       of          is         per
                           a$miatedwithlhismllecton infomation 4 minutes respondent recodkeeper
                                                                                          or            depending
                                                                                                                on
individulcirdmstances. Comm€nts          the        of
                                conceming amumcy $is burden     estimate suggesllons rcducing burden
                                                                         and             for       this      should
            to
be directed U.S.Custons Bordsr
                            and                Repons
                                      Prdtection,      Clearanm  offmr, lnfomation   Seryices Branch,          Dc
                                                                                                     Washing'ton,
20229, to theOffceofManagemont Budget,
       and                        and        PapeMo*Reducdon    Project
                                                                      (1651.0009),              DC
                                                                                    Washington, 20503.   THISFORM
I{AYNOTgE REPRODUCED        WTHOUT  APPROVAT   FROI,I THECBPFORMS     MAI'IAGER
'u.S. G.Po.:2005 - 783-076/80026
                                                                                 CBP Form 60598 (01/04)