Form DS-4071 Export Declaration of Defense Technical Data and Service

Shipment Report

U. S. DEPARTMENT OF STATE

Export Declaration of Defense Technical Data or Services

				OMB Approval Number 1405-0157
Company Name:				Expiration Date: 04/30/2008
Contact Name:		Phone:		*Estimated Burden: 30 minutes

Registration Type Code	Registration Number	License Type	License Number	ITAR Exemption Number

Destination Country	Port or Method of Exportation	Export Date	Value of Goods		SME			All parties to this transaction are eligible parties under 22 CFR 120.1
Unit of Measure	Quantity	Commodity Description		USML Code			Commodity Code [Reserved for future use]

	Foreign End User	Foreign Consignee	Foreign Intermediate Consignee	U. S. Consignee
Business Name
Address 1
Address 2
City
State
Country
Postal Code
Contact Name
Contact Phone

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Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: Department of State (A/ISS/DIR) Washington, DC 20520.

Form DS-4071