Form 255 Declaration of Unaccompanied Articles

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0030
Expires 08/31/2011

U.S. Customs and Border Protection
DECLARATION OF UNACCOMPANIED ARTICLES
19 CFR 145.12, 145.43, 148.110, 148.113-148.116

The arriving traveler or head of a family must complete a SEPARATE CBP Form 255 for EACH unaccompanied package or container sent from American Samoa,
Guam, or the U.S. Virgin Islands. PLEASE PRINT the information in blocks 1-8 and SIGN block 9.
1. FAMILY NAME
GIVEN NAME
MIDDLE INITIAL
2. NUMBER OF FAMILY MEMBERS
INCLUDED IN FAMILY DECLARATION

3. PERMANENT ADDRESS

4. DATE OF ARRIVAL

5. VESSEL, OR AIRLINE & FLIGHT NO.

6. PORT OF ARRIVAL
7. DESCRIPTION OF ARTICLE(S) IN PACKAGE

9.

8. PRICE

I declare that the above articles were acquired in American Samoa, Guam or the U.S. Virgin
Islands by me or those members of my family included in my declaration. I further declare that the
above information is valid and correct to the best of my knowledge and belief. I will pay any
customs duties and internal revenue taxes which are found to be due upon arrival of the articles.
SIGNATURE

X
IMPORTANT

To receive your entitled exemptions and appropriate rates of duty, you must send
the yellow copy of CBP Form 255 to the vendor immediately after customs
validation (Blocks 10 and 11).
VENDOR:
1. Enclose this form in an envelope marked "CBP Form 255 enclosed"
and securely attach it to the outside of the package or container.
2. Mark the package or container "Unaccompanied Tourist Shipment."
Paperwork Reduction Act Statement: An agency may not conduct or sponsor an
information collection and a person is not required to respond to this information
unless it displays a current valid OMB control number and an expiration date. The
control number for this collection is 1651- 0030. The estimated average time to
complete this application is 5 minutes. If you have any comments regarding the
burden estimate you can write to U.S. Customs and Border Protection, Office of
Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.
IMPORTER:

10. CBP USE ONLY (After arrival of traveler)

11. CBP OFFICER SIGNATURE

DATE

WARNING
FALSE CLAIMS ARE PUNISHABLE BY LAW
CBP USE ONLY (After arrival of article)
12. ARRIVAL DATE
13. MAIL OR INFORMAL ENTRY NO.
14. RELEASE DATE

15. CBP OFFICER

16. DISCREPANCIES BETWEEN CBP FORM 255 AND SHIPMENT

CBP Form 255 (06/00)