Form 7552 Delivery Certificate for Purposes of Drawback

OMB 1651-0075 Exp. 08-31-2008

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
DELIVERY CERTIFICATE FOR PURPOSES OF DRAWBACK

Certificate of Delivery
1. CM&D No.

19 CFR 191

Certificate
of
Manufacture
and
Delivery

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We
askfor the information in order to carry out U.S. Department of Homeland Security laws and regulations, to determine
the eligibility for refund of taxes on domestic alcohol (if applicable), and to determine the proper amount of drawback.
Your response is required to obtain or retain a benefit. The estimated average burden associated with this collection
of information is 33 minutes per respondent depending on Individual circumstances. Comments concerning the
accuracy of this burdent estimate and suggestions for reducing this burden should be directed to U.S. Customs and
Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and
Budget, Paperwork Reduction Project (1651-0075) Washington, DC 20503

6. FROM TRANSFEROR:

4. Type
Code

2. Port
Code

3. DBK Ruling No.

5. ID No. of Transferor

7. TO TRANSFEREE:

RECEIVED DATE

Company Name

Company Name and Complete Address

Complete Address

IMPORTED DUTY PAID, DESIGNATED MERCHANDISE OR DRAWBACK PRODUCT
8.
Use

9.
Import Entry
or
CM&D Number

10.
Port
Code

21. Contact Name and Address

11.
Import
Date
(mm/dd/yyyy)

12.
CD

13. (If using 1313(b))
A.
B.
Date(s)
Date(s)
Received
Used

14.
Date
Delivered

15.
HTSUS
No.

16.
Description
Of Merchandise
(Include Part Numbers)

PREPARER
Phone Number

17.
Quantity
&
Unit of
Measure

18.
Entered
Value
Per Unit

19.
100%
Duty

20.

Total

Ext.

FAX Number
CBP Form 7552 (08/01)

22.
Quantity & Description
of Merchandise Used

23.
Date(s) of
Manufacture

27.
Duty Available on Manufacture Articles
(Total of Duties in Block 20)

24.
Description of Articles Manufactured or Produced
(Include Part Numbers)

28.
Drawback Available Per Unit of Measure
on Manufactured Article

25.
Quantity &
Unit of
Measure

26.
Date Delivered

29.
Factory Location

30. Exhibits to be attached for the following:
Relative Value

Petroleum

Domestic Tax Paid Alcohol

Piece Goods

Waste Calculation

Recycled

Merchandise Processing Fee

31. STATUS - Import Entries listed on this form are subject to (If CD, identify on this form; if CM&D, identify on coding sheet):
Reconciliation

Protest, 514

520 (c) (1)

520 (d)

DECLARATIONS
The merchandise transferred on this CD is the imported merchandise.
The merchandise transferred on this CD is pursuant to 19 U.S.C. 13130)(2) and will not be designated for any other Drawback purposes.
The article(s) described above were manufactured or produced and delivered as stated herein in accordance with the Drawback ruling on file with CBP and in compliance with
applicable laws and regulations.
This Certificate of Delivery is a subsequent transfer and the merchandise is the same as received.

The undersigned acknowledges statutory requirements that all records supporting the information on this document are to be retained by the issuing
party for a period of three years from the date of payment of the related drawback entry.
Assignment of Rights is transferred when this form is prepared as a CD or CM&D.
I declare that according to the best of my knowledge and belief, all of the statements in this document are correct and I am fully aware of the sanctions
provided in18 U.S.C.1001 and 18 U.S.C. 650 and 19 U.S.C. 1593a.

Member of Firm with Power of Attorney
Printed Name and Title

Officer of Corporation

Broker with Power of Attorney

Signature and Date

CBP Form 7552 (08/01)(Back)