REPAIR OR ALTERATION DECLARATION OF SHIPPER (HTS 9802.00)
SHIPPER/SELLER (Name & Address) CONSIGNEE/BUYER (Name & Address)
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 _____
(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
FUNDS: q U.S. FUNDS: q U.S.
q CAN q CAN
q COMPLETE RETURN q PARTIAL RETURN q PARTIAL & FINAL RETURN