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Repair or Alteration Declaration

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					               REPAIR OR ALTERATION DECLARATION OF SHIPPER (HTS 9802.00)
SHIPPER/SELLER (Name & Address)                                     CONSIGNEE/BUYER (Name & Address)




                                                 SHIPPER’S DECLARATION

   I, __________________________________________ , declare that the articles herein specified are the articles

   which, in the condition in which they were exported from the U.S. were received by me (us)

   on ___________________________________ , 20 _____

   From: _____________________________________________________________________________________
          (Name and Address of owner or exporter in the United States)

   that they were received by me (us) for the sole purpose of being repaired, altered, or processed. The only repairs, alterations
   or processing described below were effected by me (us), that the full cost of (when no charge is made) fair market value of
   such repairs alterations or processing are correctly stated below and that no substitution whatever has been made to replace
   any of the articles originally received by me (us) from the owner or exporter thereof mentioned above.


MARKS &                         DESCRIPTION OF ARTICLES                                    FULL COST OF            TOTAL VALUE OF
NUMBERS              (Describe Repairs, Alterations, or Processing in Detail)              REPAIRS, etc.           ARTICLES AFTER
                                                                                                                    REPAIRS, etc.




                                                                                        FUNDS:     q U.S.        FUNDS:     q U.S.
                                                                                                   q CAN                    q CAN
        q      COMPLETE RETURN             q     PARTIAL RETURN                 q     PARTIAL & FINAL RETURN




       Date:

      Name:

   Capacity:                                                      Signature:

				
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posted:3/28/2010
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