Form 26 Report of Diversion

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0025
Exp. 10-31-2011

U.S. Customs and Border Protection
REPORT OF DIVERSION
19 CFR 4.91 (a) and (b)

1. PORT WHICH GRANTED CLEARANCE OR PERMIT TO PROCEED

2. NATIONALITY (American or Foreign)

3. NAME OF VESSEL

4. RIG

5. DATE

CBP PORT DIRECTOR

6. NAME OF PORT TO WHICH CLEARED

7. DATE OF CLEARANCE

8. ACTUAL/EXPECTED PORT OF ARRIVAL

9. DATE OF ARRIVAL

PLEASE NOTIFY THE PORT DIRECTOR AT THE PORT OF ARRIVAL. (The port director will act only when timely notified under
section 4.91(a), and 4.91(b), of the Customs Regulations)
AND/OR
GRANT RELIEF FROM ANY PENALTY TO WHICH THE MASTER OWNER OR AGENT MAY BE LIABLE UNDER 46 U.S.C. 91 CR
19 U.S.C. 1445.
10. REASONS

11. REPORT SUBMITTED BY
14. PENALTY CASE NUMBER
16. PENALTY ASSESSED AGAINST

13. DATE

12. TITLE (Owner, Master, or Agent)

15. AMOUNT OF PENALTY

$

Port
17. SECTION OF LAW VIOLATED

18. RECOMMEND THAT THE PENALTY BE
Remitted

Mitigated to

$

19. CBP PORT DIRECTOR BY
21. PURSUANT TO THE AUTHORITY CONTAINED IN 19 U.S.C. 1618 OR 46 U.S.C. 7, THE ABOVE PENALTY IS
Remitted
Mitigated to
22. SIGNATURE OF CBP PORT DIRECTOR BY

20. DATE

$
23. DATE

NOTE: No notice of remission will be furnished. If no notice is received within 30 days, the petitioner may presume that penalty has been remitted.
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 1651-0025. 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.

CBP Form 26 (06/09)