214C Application for Foreign-Trade Zone Admission and/or Stat

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

DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection

1. ZONE NO. AND LOCATION (Address)

APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION

2. PORT CODE

CONTINUATION SHEET

6. ZONE ADMISSION NO.

19 CFR 146.32, 146.40
15.
NO. OF
PACKAGES
AND COUNTRY
OF ORIGIN CODE

16.
DESCRIPTION OF MERCHANDISE

(See back of form for Paperwork Reduction Act Notice.)

17.
HTSUS NO.

STATISTICAL COPY

18.
QUANTITY
(HTSUS)

19.
GROSS
WEIGHT

20.
SEPARATE
VALUE & AGGR
CHGS.

CBP Form 214C (08/00)

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 depending on individual circumstances. Comments concerning the
accuracy of this burden 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 (1651-0029), Washington, DC 20503.

CBP Form 214C (08/00) (Back)