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pdfU.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0104
Expires: 03/31/2008
Estimated burden: 15 Minutes
See Page 6
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title:
Purpose
Official (Explain Below)
Personal
Enter PID
or
If Newly Assigned Check Here
Official and Personal
Carrier/Supplier
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
06-2006
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
U.S. CUSTOMS COPY
Page 1 of 6
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0104
Expires: 03/31/2008
Estimated burden: 15 Minutes
See Page 6
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title:
Purpose
Official (Explain Below)
Personal
Enter PID
or
If Newly Assigned Check Here
Official and Personal
Carrier/Supplier
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
APPROVED COPY
Page 2 of 6
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0104
Expires: 03/31/2008
Estimated burden: 15 Minutes
See Page 6
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title:
Purpose
Official (Explain Below)
Personal
Enter PID
or
If Newly Assigned Check Here
Official and Personal
Carrier/Supplier
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
U.S. CUSTOMS COPY
Page 3 of 6
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0104
Expires: 03/31/2008
Estimated burden: 15 Minutes
See Page 6
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title:
Purpose
Official (Explain Below)
Personal
Enter PID
or
If Newly Assigned Check Here
Official and Personal
Carrier/Supplier
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
U.S. Department of State
Approval
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Free Entry Requested
U.S. CUSTOMS COPY
Page 4 of 6
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0104
Expires: 03/31/2008
Estimated burden: 15 Minutes
See Page 6
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title:
Purpose
Official (Explain Below)
Personal
Official and Personal
Carrier/Supplier
Enter PID
or
If Newly Assigned Check Here
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
Date (mm-dd-yyyy)
DS-1504
Date (mm-dd-yyyy)
USUN
U.S. Department of State
Approval
U.S. Customs Authorization
Free Entry Requested
OFM COPY
Page 5 of 6
U.S. Department of State
REQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISE
OMB Approval No. 1405-0104
Expires: 03/31/2008
Estimated burden: 15 Minutes
See Page 6
To the Secretary of State - Attention: Office of Foreign Missions
It is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This
merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives of
international organizations, or others herein designated, based on privileges under the authority specified on the form.
Name of Embassy, Legation, or International Organization (Includes U.N.)
Port of Clearance
Consignee
Name (First, Middle, Last)
Title:
Purpose
Official (Explain Below)
Personal
Enter PID
or
If Newly Assigned Check Here
Official and Personal
Carrier/Supplier
Customs Entry or Manifest Number
Air Waybill or Bill of Lading Number
Total Weight lbs. or kg.
Mail Entry Number
Description of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone).
If vehicle, include Vehicle Identification Number, Make, Model, and Year.
Signature of Authorized Representative of International Organization (Includes U.N.)
Embassy or Consulate Seal
and Authorization
U.S. Department of State
Approval
Signature
of Authorized Representative of International Organization (Includes U.N.)
Date
(mm-dd-yyyy)
Free Entry Requested
Date (mm-dd-yyyy)
USUN
U.S. Customs Authorization
Date (mm-dd-yyyy)
PAPERWORK REDUCTION ACT STATEMENT
Embassy or Consulate Seal
USUN
U.S. Customs Authorization
U.S. Department of State
Authorization
Approval
The Publicand
reporting
burden for this collection of information
is estimated to average (insert time in minutes or hours) per response. This includes the time
required for searching existing data sources, gathering the necessary data and/or documentation, providing the information and/or documents required,
and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid Office of Management and
Budget (OMB) number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to:
Information Collections Coordinator, U.S. Department of State, A/RPS/DIR, Washington, DC 20520.
Date (mm-dd-yyyy)
DS-1504
Free Entry Requested
CUSTOMER COPY
Page 6 of 6
| File Type | application/pdf |
| File Title | DS-1504 |
| Author | ciupekra |
| File Modified | 2008-05-05 |
| File Created | 2008-05-05 |