Form 214 Application for Foreign Trade Zone Admission and/or Stat

OMB No. 1651-0029 Exp. 01-31-2010

DEPARTMENT OF HOMELAND SECURITY

1. ZONE NO. AND LOCATION (Address)

U.S. Customs and Border Protection
APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION

CENSUS USE ONLY

2. PORT CODE
19 CFR 146.22, 146.32, 146.35-146.37, 146.39-146.41, 146.44, 146.53, 146.66
3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER

5. IMPORT DATE

4. EXPORT DATE

6. ZONE ADMISSION NO.

7. U.S. PORT OF UNLADING

8. FOREIGN PORT OF LADING

9. BILL OF LADING/AWB NO. 10. INWARD M'FEST NO.

11. INBOND CARRIER

12. I.T. NO. AND DATE

13. I.T. FROM (Port)

14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT?
15.
NO. OF
PACKAGES
AND COUNTRY
OF ORIGIN CODE

17.
HTSUS NO.

16.
DESCRIPTION OF MERCHANDISE

YES
18.
QUANTITY
(HTSUS)

NO
19.
GROSS
WEIGHT

20.
SEPARATE
VALUE & AGGR
CHGS.

21. HARBOR MAINTENANCE FEE (19 CFR 24.24)
22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone. I declare to the best of my knowledge and belief that the above
merchandise is not prohibited entry in the Foreign-Trade Zone within the meaning of section 3 of the Foreign-Trade Zones Act of 1934, as amended,
and section 146.31, Customs Regulations.
23. I hereby apply for the status designation indicated:
ZONE RESTRICTED
PRIVILEGED FOREIGN
DOMESTIC
NONPRIVILEGED FOREIGN
(19 CFR 146.44)
(19 CFR 146.41)
(19 CFR 146.43)
(19 CFR 146.42)
27. DATE
24. APPLICANT FIRM NAME
26. TITLE
25. BY (Signature)

F.T.Z. AGREES TO RECEIVE
MERCHANDISE INTO THE ZONE
PERMIT
PERMIT

28. FOR THE F.T.Z. OPERATOR (Signature)

Permission is hereby granted to 31. PORT DIRECTOR OF CBP: BY (Signature)
transfer the above merchandise
into the Zone.
The above merchandise has been 34. PORT DIRECTOR OF CBP: BY (Signature)
granted the requested status.
37. The goods described herein are authorized to be transferred:

PERMIT
TO
TRANSFER

38. CBP OFFICER AT STATION (Signature)

29. TITLE

30. DATE

32. TITLE

33. DATE

35. TITLE

36. DATE

without exception

39. TITLE

42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature) 43. CARTMAN

except as noted below

40. STATION

41. DATE

44. CHL NO.

45. DATE

46. To the Port Director of CBP: The above merchandise was received at the Zone on the date shown except as noted below:
FTZ
OPERATOR'S
REPORT OF
MERCHANDISE
RECEIVED AT
49. DATE
48. TITLE
47. FOR THE FTZ OPERATOR (Signature)
ZONE

(See page 2 for Paperwork Reduction Act Notice.)

Previous Editions are Obsolete

CBP Form 214 (02/96)

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork
Reduction Act. We ask for the information in order to carry out the laws and regulations administered
by U.S. Customs and Border Protection and Foreign-Trade Zones Board. These regulations and
forms apply to importers/exporters to ensure that they are complying with these laws. It is mandatory.
The estimated average burden associated with this collection of information is 15 minutes per
respondent and depending on individual circumstances. Comments concerning the accuracy of this
burden estimate and suggestions for reducing this burden should bedirected to U.S. Customs and
Border Protection, Information Services Branch, Washington DC 20229, and to the Office of
Management and Budget, Paperwork Reduction Project (1651-0029), Washington, DC 20503.

CBP Form 214 (02/96)