Form DSP-85 Application/License for the Permanent/Temporary Export o

Application/License for the Permanent/Temporary Export or Temporary Import of Classified Defense Articles and Classified Technical Data

DSP-85, Form

Application/License for the Permanent/Temporary Export or Temporary Import of Classified Defense Articles and Classified Technical Data

OMB: 1405-0022

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1405-0022 can be found here:

2021-12-02 - Reinstatement without change of a previously approved collection
2020-01-31 - No material or nonsubstantive change to a currently approved collection

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DO NOT REMOVE THIS TAB
PLEASE READ INSTRUCTIONS AND REMOVE THIS INSTRUCTION PAGE BEFORE TYPING

INSTRUCTIONS FOR DSP-85
Applications must be typed. Remove Copy 6 (APPLICATION) before mailing this application to the Directorate of Defense Trade Controls (PM/DDTC). Do
NOT detach the perforated tab at the top of the form. All items on the application form should be completed fully. If necessary, type "NONE" or "SAME AS
ITEM __________ ." Do not type "N/A."

CHECKLIST OF DOCUMENTS TO BE SUBMITTED WITH DSP-85
1. Attachments (Addendum/Continuation Sheets): When required, three copies to accompany application with identical precedents; nine copies for all other
applications. If addendum is freight forwarder list only, submit original and two copies. All continuation sheets should identify the country, date of preparation,
PM/DDTC registrant/applicant code, and total dollar value shown on the application form.
2. Descriptive Literature: Two sets for applications with identical precedent (e.g., spare parts shipment); seven sets for all others.
3. Precedent Approvals: One copy each of precedent license(s) or agreement(s) for applications with identical histories; seven copies for all others. Include any
proviso letter(s).
4. Verification of Purchase: One copy of purchase order, letter of intent, or other appropriate document from purchaser, which indicates end use,
end user, quantity and price.
5. If required by 22 CFR 130.10, a Statement on Political Contributions, Fees and Commissions: Signed and dated original plus one copy.
6. Letter of Explanation: When appropriate to explain a complicated case. Original plus attachments for cases with identical precedents; original and six copies

GENERAL INSTRUCTIONS
1. "RETURN TO APPLICANT" should be stamped on each copy of descriptive
literature that the company wishes to have returned.
2. Copies of information must be collated into sets.
3. Photocopies of approved licenses may be made for recordkeeping
purposes only, not for making shipments.
4. Hardware applications (defense articles excluding technical data) may
reflect only one country of ultimate destination. Defense articles and related
data may not be re-exported or transferred to any other country or to a national
of any other country without the prior written approval of the U.S. Department
of State.
5. Several countries may be listed in block 4 for technical data exports only.
However, when the countries of ultimate destination are geographically
dispersed, submit a separate application for each major geographical region
(e.g., Africa, South Asia, East Asia, Europe, etc.). An addendum to the
application must identify all countries/parties to the export.
6. Customs authorities may authorize shipments of hardware when the total
value of the shipment does not exceed the aggregate value on the license by
more than 10%. If the value has increased by more than 10% a new license is
required. Quantities may not be amended, and additions should be treated as
new orders and result in a new license request.

7. End use must be indicated in writing before applying for licenses.
Hardware applications must be accompanied by the customer's verification
of purchase or other appropriate document which indicates end use, end
user, price and quantity.
8. All applications for SME valued at $14 million or more for end use by
foreign armed forces (other than a member of the North Atlantic Treaty
Organization, Australia, New Zealand or Japan) must include a statement
referring to prior approval or prior notification by the U.S. State Department
in Item 11 or in an attached cover letter (see 22 CFR 126.8).
9. Firearms and firearm ammunition applications must be accompanied by
import verification issued by the government of the recipient country, if
applicable.
10. Provide the facility security clearance code (FSC) and safeguarding
level of each commercial party that will have access or title to, or custody or
control of, the shipment.
The Defense Investigative Service (DIS)
Cognizant Security Office should be requested to obtain this information for
each foreign commercial intermediate and ultimate consignee. If a party to
this transaction has applied for, but not received the FSC, type "Application
Pending" in the appropriate space.
11. For blocks 16, 17, 18, 19, and 20, be sure to include the Facility
Clearance Code, the level of the clearance, and the date of the FSC. Be
specific, since this may or may not be the applicant. For blocks 17 and 19,
contact your local Defense Investigative Service (DIS) office to obtain the
required FSC data.

SPECIFIC GUIDELINES
Item 2

Applicant must be currently registered with PM/DDTC. Enter the
complete number assigned to applicant at time of registration or
renewal. See 22 CFR 122. For registration information call (202)
663-2815.
Item 4 Enter the country of ultimate destination or temporary sojourn. If
license is in support of an agreement, the country of ultimate
destination should be the country where the
manufacturer/distributor is located.
Item 6 Check appropriate block to identify applicant. The first line MUST
reflect name under which company is registered. Subsequent
lines may identify a specific subsidiary of the applicant company.
If subsidiary company is listed, list the subsidiary's FSC.
Check the appropriate block to identify the government agency
Item 7 responsible for the classification of the hardware or technical
data. Include the name and telephone number of the program
manager or other responsible official at the government agency.
If you check "Other" enter the name of the agency in the space
provided. If foreign government information (FGI) is being
exported, check "Other"and identify the country in this block.
Identify an individual within your company who is familiar with this
application. This individual must know the security arrangements
Item 8 associated with the export or import of the classified hardware or
technical data.
Check the appropriate block in section a, b, and c. If the
identical commodity has not been previously licensed, but a
Item 9 similar commodity has been licensed, check the appropriate box
and type SIMILAR in front of the license number. In all cases,
include precedent Technical Assistance, Manufacturing License
or Warehouse and Distribution Agreement case numbers where
appropriate. Attach copies of referenced licenses or agreement
and proviso letters.
Specify number of end items and major components to be
shipped or other appropriate means of accountability (e.g., "Lot,"
Item 10 "Set," etc.). "LOT" can be used only for minor components or
parts and technical data but an itemized list must be attached.
Check "Hardware" or "Technical Data" or both if you are exporting
both and you have itemized both in the commodity listing. List
each commodity, giving type, model number, catalog or part
Item 11 number. Use continuation sheet if necessary.
Enter the classification of each item of hardware or technical data
as follows: TS for Top Secret, S for Secret, C for Confidential, or
R for foreign government RESTRICTED. If foreign government
Item 12 information (FGI) is being exported, the letters FGI should be
placed to the right of the classification and the country identified in
Item 4.
Enter U.S. Munitions List category. Include specific
subparagraph as appropriate. See 22 CFR 121.1.
Item 13

Item 14

Item 15
Item 16

Item 17
Item 19

Item 20

Item 21

Item 22

Item 23

Item 24

Value for hardware should include the selling price for each line item
without supplementary costs such as packing and freight. Value for
technical data may be identified as "NONE" or reflect reproduction
and/or processing costs.
Enter total value of items in U.S. dollars (including any items on
continuation sheets).
Check appropriate block and type the name and address of the
source or manufacturer. When possible specify whether the material
is new or used, and whether the material was acquired from U.S.
Government surplus channels.
The FSC requirement applies only to foreign entities other than
foreign governments.
Identify the individual or company authorized by the foreign end- user
to receive the shipment for storage, modification or incorporation into
an end-item for forwarding to the foreign end- user. The foreign
consignee is sometimes not the same as the foreign end-user and
can even be located in a country other than the country of the foreign
end-user. If the foreign consignee is the same as the foreign
end-user, type "Same as Item 17."
Enter the complete name and address of U.S. freight forwarder(s) or
consignor(s), and give the date and level of security clearance for
each facility listed. Use addendum sheet(s) if necessary.
22 CFR 126.13 requires that all parties to the export be shown on all
applications.
Enter the specific purpose and end-use or end-item for which the
commodity in Item 11 is being purchased (e.g., turbine blades for jet
engine for __ aircraft), and if appropriate, explain foreign consignee
involvement in the transaction. If hardware is being exported in
furtherance of an approved agreement, provide the PM/DDTC case
number.
Provide the name and address of the DIS Security Office responsible
for administering the government-to-government transfer at the
location where the classified hardware or technical data is packaged
for shipment.
Enter the name of the person empowered to sign the application.
Check the appropriate statement(s). Read the statements on the
reverse of the form carefully and check the appropriate items. Sign
the application in ink on the signature line. This signature certifies
compliance with the provisions of 22 CFR 126.13 (statement on
reverse of form) and other requirements of 22 CFR 120-130. BE
SURE TO COMPLETE THE REVERSE SIDE OF THE PAGE BY
CHECKING THE APPROPRIATE BLOCK. In instances where you
are empowered to sign the application but are not empowered by the
applicant to certify that the conditions of 22 CFR 126.13 and 130 have
been met, submit a separate letter(s) from an empowered official in
your company who is authorized to provide the certification.
Enter complete address to which license should be mailed. Do not
enter "SAME AS ITEM 6."

MAILING ADDRESS: PM/DDTC, SA-1, 12th Floor, Directorate of Defense Trade Controls, Bureau of Political-Military Affairs, U.S. Department of State, Washington, D.C. 20522-0112.
DELIVERY ADDRESS: U.S. Department of State, PM/DDTC, SA-1, 12th Floor, 2401 E Street, NW, Washington DC 20037.

DSP-85
07-2008

Instruction Page 1 of 1

(U.S. DEPARTMENT OF STATE USE ONLY)

SEAL
Signature

License is hereby granted to the applicant for the described commodity to be
permanently exported from the U.S., to be temporarily exported from and
returned to the U.S., or to be temporarily imported into the U.S. and returned to
the foreign owner, provided shipment is made in accordance with the
Department of Defense Industrial Security Manual. This license may be
revoked, suspended or amended by the Secretary of State without prior notice
whenever the Secretary deems such action advisable.

UNITED STATES OF AMERICA

LICENSE VALID FOR 48
MONTHS FROM ABOVE DATE

LICENSE NO.
U.S. DEPARTMENT OF STATE

APPLICATION/LICENSE FOR PERMANENT/ TEMPORARY EXPORT OR TEMPORARY
IMPORT OF CLASSIFIED DEFENSE ARTICLES AND CLASSIFIED TECHNICAL DATA
1. Date prepared
(mm-dd-yyyy)

2. PM/DDTC Applicant/
Registrant Code

4. Country of ultimate destination or
sojourn

3. Check one:
Permanent export

5. Country from which shipped
(temporary imports only)

Temporary export
Temporary import
7. Names, agency and telephone numbers of U.S. Government personnel
(not PM/DDTC) familiar with the commodity

6. Applicant's Name, Address, ZIP Code, Telephone Number
government
agent/manufacturer
freight forwarder
Applicant is:

Army

Air Force

Navy

Other

8. Name, and telephone number of applicant contact if U.S. Government
needs additional information
FSC, level and date of clearance
Telephone Number:
9. Description of Transaction
a. This application represents:

ONLY completely new shipment;

b. The IDENTICAL commodity:

was licensed to the country in block 4 under license no.

was licensed to other countries under license no.

ONLY the unshipped balance of license no.
;
was returned without action under voided license no.

;

was denied to the country in block 4 under voided licensed no.
c. If commodity is being financed under

;
Foreign Military Financing (FMF); or

Foreign Military Sale (FMS);

Grant Aid Program, give the case number
10.

Quantity

11. Commodity

Hardware

.
12. Class.

Technical Data

;

was never licensed for this applicant.

13. USML Category

14.

Value

15. Total Value: $
16.

Source or

Manufacturer of Commodity

17. Name and address of foreign end-user

FSC, level and date of clearance
18. Name and address of seller in United States

FSC, level and date of clearance:
19. Name and address of foreign consignee

FSC, level and date of clearance

FSC, level and date of clearance:

20. Name and address of consignor and/or freight forwarder in U.S.

21. Specific purpose for which the material is required, including specific
program/end item

FSC, level and date of clearance
22. Name and address of cognizant DIS security office

23. Applicant's Statement (see instructions)
I,

Typed name

, hereby apply for a license to complete

the transaction described above; warrant the truth of all statements made herein; and
acknowledge, understand and will comply with the provisions of 22 CFR 120-130, and any
conditions and limitations imposed, and the DOD Industrial Security Manual.
CHECK ALL THAT APPLY:

24. License copy to be sent to: Name, address, ZIP code

I am a responsible official empowered by the applicant to certify that the conditions
of 22 CFR 126.13 and 22 CFR 130 as listed on the reverse of this form have been met
in full.
The applicant or another party to this export cannot meet one or more of the
conditions in 22 CFR 126.13. A request for an exception to policy is attached.
U.S. consignor(s) and/or freight forwarder list(s) is/are attached.
Signature

1 - APPLICATION/LICENSE

OMB NO. 1405-0022
EXPIRATION DATE: 09-30-2008
ESTIMATED BURDEN: 1 Hour*

*Public reporting burden for this collection of information is estimated to average 1 hour 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: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.

DSP-85
07-2008

Page 1 of 7

APPLICANT'S STATEMENT
(See Instructions)

I am a responsible official empowered by the applicant to certify the following in compliance with 22 CFR 126.13:
(1) Neither the applicant, its chief executive officer, president, vice presidents, other senior officers or officials (e.g., comptroller, treasurer,
general counsel) nor any member of its board of directors is:
(a) the subject of an indictment for or has been convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR 120.27
since the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 (June 30, 1976); or
(b) ineligible to contract with, or to receive a license or other approval to import defense articles or defense services from, or to receive an
export license or other approval from any agency of the U.S. Government;
(2) To the best of the applicant's knowledge, no party to the export as defined in 22 CFR 126.7 (e) has been convicted of violating any of the
U.S. criminal statutes enumerated in 22 CFR 120.27 since the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729
(June 30, 1976), or is ineligible to contract with, or to receive a license or other approval to import defense articles or defense services from,
or to receive an export license or other approval from any agency of the U.S. Government; and
(3) The natural person signing the application or other request for approval, or notification is (check one only):
a citizen of the U.S., OR
has been lawfully admitted to the U.S. for permanent residence (and maintains such residence) under the Immigration and
Nationality Act, as amended, (8 U.S.C. 1101(a), 101(a)20, 60 Stat. 163) OR
is an official of a foreign government entity in the U.S.
The following is certified in compliance with 22 CFR 130:
(check appropriate box)
Neither the applicant nor its vendors have paid, or offered or agreed to pay, in respect of any sale for which a license or approval is
requested, political contributions, fees or commissions in amounts as specified in 22 CFR 130.9(a).
The applicant or its vendors have paid, or offered or agreed to pay, in respect of any sale for which a license or approval is requested,
political contributions, fees or commissions in amounts as specified in 22 CFR 130.9(a). Information required under 22 CFR 130.10 is
attached in a letter (original and one copy).

CONDITIONS OF ISSUANCE
1. This license is issued under the conditions cited in 22 CFR 120 - 130, including the provisos as applicable, that:
A. It shall not be construed as implying U.S. Government approval or commitment to authorize future exports of any article (equipment or technical data) on
the Munitions List, or any U.S. Government commitment with regard to any proposed manufacturing licence or technical assistance agreements which may
result from an authorized export.
B. If a license is issued for technical data only, it does not authorize the export of any hardware; if a license is issued for hardware only, it does not authorize
the export of any technical data, unless specifically covered by an exemption.
2. The issuance of this license does not release the licensee from complying with other requirements of U.S. law and regulations.
3. The prior written approval of the U.S Department of State must be obtained before U.S. Munitions List articles exported from the U.S. under license
or other approval may be resold, diverted, transferred, transshipped, reshipped, reexported to, or used in any country, or to any end-user, other than
described on the license or other approval as the country of ultimate destination or the ultimate end-user.

that

RETURN OF LICENSE
This license must be returned to PM/DDTC, SA-1, 12th Floor, Directorate of Defense Trade Controls, Bureau of Political-Military Affairs, U.S. Department of
State, Washington, DC 20522-0112, when: (1) the total value authorized has been shipped; (2) the applicant states that there will be no further shipments; (3) the
date of expiration is reached; or (4) when requested by the Directorate of Defense Trade Controls.

ENDORSEMENT
Indicate below which ITEM on the face of the license is BEING EXPORTED and maintain a CONTINUING BALANCE of the remaining value:
SHIPMENT
DATE
(mm-dd-yyyy)

QUANTITY

COMMODITY
(including classification)

SHIPMENT
VALUE

SED NO.

INITIALS

PORT OF
EXIT/ENTRY

TOTAL AUTHORIZED VALUE:

REMAINING BALANCE:

NOTE: Continuation of additional shipments must be authenticated by use of continuation sheets in the U.S. Customs Handbook.
(In the case of classified shipments, the Defense Investigative Service (DIS) is the endorsing agency for shipments.)
DSP-85

Page 2 of 7

(U.S. DEPARTMENT OF STATE USE ONLY)

SEAL
Signature

UNITED STATES OF AMERICA

LICENSE VALID FOR 48
MONTHS FROM ABOVE DATE

LICENSE NO.
U.S. DEPARTMENT OF STATE

APPLICATION/LICENSE FOR PERMANENT/ TEMPORARY EXPORT OR TEMPORARY
IMPORT OF CLASSIFIED DEFENSE ARTICLES AND CLASSIFIED TECHNICAL DATA
1. Date prepared
(mm-dd-yyyy)

2. PM/DDTC Applicant/
Registrant Code

4. Country of ultimate destination or
sojourn

3. Check one:
Permanent export

5. Country from which shipped
(temporary imports only)

Temporary export
Temporary import
7. Names, agency and telephone numbers of U.S. Government personnel
(not PM/DDTC) familiar with the commodity

6. Applicant's Name, Address, ZIP Code, Telephone Number
government
agent/manufacturer
freight forwarder
Applicant is:

Army

Air Force

Navy

Other

8. Name, and telephone number of applicant contact if U.S. Government
needs additional information
FSC, level and date of clearance:
Telephone Number:
9. Description of Transaction
a. This application represents:

ONLY completely new shipment;

b. The IDENTICAL commodity:

was licensed to the country in block 4 under license no.

was licensed to other countries under license no.

ONLY the unshipped balance of license no.
;
was returned without action under voided license no.

;

was denied to the country in block 4 under voided licensed no.
c. If commodity is being financed under

;
Foreign Military Financing (FMF); or

Foreign Military Sale (FMS);

Grant Aid Program, give the case number
10.

Quantity

11. Commodity

Hardware

.
12. Class.

Technical Data

;

was never licensed for this applicant.

13. USML Category

14.

Value

15. Total Value: $
16.

Source or

Manufacturer of Commodity

FSC, level and date of clearance
18. Name and address of seller in United States

17. Name and address of foreign end-user

FSC, level and date of clearance:
19. Name and address of foreign consignee

FSC, level and date of clearance
20. Name and address of consignor and/or freight forwarder in U.S.

FSC, level and date of clearance:
21. Specific purpose for which the material is required, including specific
program/end item

FSC, level and date of clearance
22. Name and address of cognizant DIS security office

23. Applicant's Statement (see instructions)
I,

Typed name

, hereby apply for a license to complete

24. License copy to be sent to: Name, address, ZIP code

2 - STATISTICS

DSP-85

OMB NO. 1405-0022
EXPIRATION DATE: 09-30-2008
ESTIMATED BURDEN: 1 Hour

Page 3 of 7

(U.S. DEPARTMENT OF STATE USE ONLY)

SEAL
Signature

LICENSE VALID FOR 48
MONTHS FROM ABOVE DATE

LICENSE NO.

UNITED STATES OF AMERICA

U.S. DEPARTMENT OF STATE

APPLICATION/LICENSE FOR PERMANENT/ TEMPORARY EXPORT OR TEMPORARY
IMPORT OF CLASSIFIED DEFENSE ARTICLES AND CLASSIFIED TECHNICAL DATA
1. Date prepared
(mm-dd-yyyy)

2. PM/DDTC Applicant/
Registrant Code

4. Country of ultimate destination or
sojourn

3. Check one:
Permanent export

5. Country from which shipped
(temporary imports only)

Temporary export
Temporary import
7. Names, agency and telephone numbers of U.S. Government personnel
(not PM/DDTC) familiar with the commodity

6. Applicant's Name, Address, ZIP Code, Telephone Number
government
agent/manufacturer
freight forwarder
Applicant is:

Army

Air Force

Navy

Other

ONLY completely new shipment;

b. The IDENTICAL commodity:

was licensed to the country in block 4 under license no.

was licensed to other countries under license no.

ONLY the unshipped balance of license no.
;
was returned without action under voided license no.

;

was denied to the country in block 4 under voided licensed no.
c. If commodity is being financed under

;
Foreign Military Financing (FMF); or

Foreign Military Sale (FMS);

Grant Aid Program, give the case number
10.

Quantity

11. Commodity

Hardware

.
12. Class.

Technical Data

;

was never licensed for this applicant.

13. USML Category

14.

Value

15. Total Value: $
16.

Source or

Manufacturer of Commodity

FSC, level and date of clearance
18. Name and address of seller in United States

17. Name and address of foreign end-user

FSC, level and date of clearance:
19. Name and address of foreign consignee

FSC, level and date of clearance
20. Name and address of consignor and/or freight forwarder in U.S.

FSC, level and date of clearance:
21. Specific purpose for which the material is required, including specific
program/end item

FSC, level and date of clearance
22. Name and address of cognizant DIS security office

23. Applicant's Statement (see instructions)
I,

Typed name

, hereby apply for a license to complete

24. License copy to be sent to: Name, address, ZIP code

3 - PM/DDTC

DSP-85

OMB NO. 1405-0022
EXPIRATION DATE: 09-30-2008
ESTIMATED BURDEN: 1 Hour

Page 4 of 7

PROCESSING RECORD
STAFFING
REQUESTED BY:
AGENCY

DATE (mm-dd-yyyy):
REPLY DATE
(mm-dd-yyyy)

NO OBJ.

NO OBJ.
W/PROV.

DATE STAFFED (mm-dd-yyyy):

OBJ.

DTSA/STLM
PM/RSAT
PM/PPA
EAP/RSP
EUR/RPM
EUR/PRA
NEA/RRP
AF/RA
WHA/PPCP
SA/RA
OES/SAT
NP/CBM
NP/ECNP
DRL/MLA
L/PM
NASA
ENERGY
COMMERCE
DOT/SCG

FINAL ACTION
DATE

(mm-dd-yyyy)

RELEASED FOR
FINAL REVIEW
FINAL ACTION
RECOMMENDED
FINAL ACTION
AUTHORIZED
ATTACHMENTS

INITIALS

APPROVE

APPROVE
W/PROV.

STAMP NO

AUDIT

DISAPPROVE

RETURN W/O
ACTION

AMENDMENTS:

NOTES:

DSP-85

Page 5 of 7

THIS IS NOT A LICENSE
METHOD OF ISSUANCE

This "Licensee" copy will serve as notification that
the approved "License" was sent to the DIS
address shown in item 22.

LICENSE VALID FOR 48
MONTHS FROM ABOVE DATE

LICENSE NO.

UNITED STATES OF AMERICA

U.S. DEPARTMENT OF STATE

APPLICATION/LICENSE FOR PERMANENT/ TEMPORARY EXPORT OR TEMPORARY
IMPORT OF CLASSIFIED DEFENSE ARTICLES AND CLASSIFIED TECHNICAL DATA
1. Date prepared
(mm-dd-yyyy)

2. PM/DDTC Applicant/
Registrant Code

4. Country of ultimate destination or
sojourn

3. Check one:
Permanent export

5. Country from which shipped
(temporary imports only)

Temporary export
Temporary import
7. Names, agency and telephone numbers of U.S. Government personnel
(not PM/DDTC) familiar with the commodity

6. Applicant's Name, Address, ZIP Code, Telephone Number
government
agent/manufacturer
freight forwarder
Applicant is:

Army

Air Force

Navy

Other

ONLY completely new shipment;

b. The IDENTICAL commodity:

was licensed to the country in block 4 under license no.

was licensed to other countries under license no.

ONLY the unshipped balance of license no.
;
was returned without action under voided license no.

;

was denied to the country in block 4 under voided licensed no.
c. If commodity is being financed under

;
Foreign Military Financing (FMF); or

Foreign Military Sale (FMS);

Grant Aid Program, give the case number
10.

Quantity

11. Commodity

Hardware

.
12. Class.

Technical Data

;

was never licensed for this applicant.

13. USML Category

14.

Value

15. Total Value: $
16.

Source or

Manufacturer of Commodity

FSC, level and date of clearance
18. Name and address of seller in United States

17. Name and address of foreign end-user

FSC, level and date of clearance:
19. Name and address of foreign consignee

FSC, level and date of clearance
20. Name and address of consignor and/or freight forwarder in U.S.

FSC, level and date of clearance:
21. Specific purpose for which the material is required, including specific
program/end item

FSC, level and date of clearance
22. Name and address of cognizant DIS security office

23. Applicant's Statement (see instructions)
I,

Typed name

, hereby apply for a license to complete

24. License copy to be sent to: Name, address, ZIP code

5 - LICENSEE

DSP-85

OMB NO. 1405-0022
EXPIRATION DATE: 09-30-2008
ESTIMATED BURDEN: 1 Hour

Page 6 of 7

THIS IS NOT A LICENSE

UNITED STATES OF AMERICA

U.S. DEPARTMENT OF STATE

APPLICATION/LICENSE FOR PERMANENT/ TEMPORARY EXPORT OR TEMPORARY
IMPORT OF CLASSIFIED DEFENSE ARTICLES AND CLASSIFIED TECHNICAL DATA
1. Date prepared
(mm-dd-yyyy)

2. PM/DDTC Applicant/
Registrant Code

4. Country of ultimate destination or
sojourn

3. Check one:
Permanent export

5. Country from which shipped
(temporary imports only)

Temporary export
Temporary import
7. Names, agency and telephone numbers of U.S. Government personnel
(not PM/DDTC) familiar with the commodity

6. Applicant's Name, Address, ZIP Code, Telephone Number
government
agent/manufacturer
freight forwarder
Applicant is:

Army

Air Force

Navy

Other

ONLY completely new shipment;

b. The IDENTICAL commodity:

was licensed to the country in block 4 under license no.

was licensed to other countries under license no.

ONLY the unshipped balance of license no.
;
was returned without action under voided license no.

;

was denied to the country in block 4 under voided licensed no.
c. If commodity is being financed under

;
Foreign Military Financing (FMF); or

Foreign Military Sale (FMS);

Grant Aid Program, give the case number
10.

Quantity

11. Commodity

Hardware

.
12. Class.

Technical Data

;

was never licensed for this applicant.

13. USML Category

14.

Value

15. Total Value: $
16.

Source or

Manufacturer of Commodity

FSC, level and date of clearance
18. Name and address of seller in United States

17. Name and address of foreign end-user

FSC, level and date of clearance:
19. Name and address of foreign consignee

FSC, level and date of clearance
20. Name and address of consignor and/or freight forwarder in U.S.

FSC, level and date of clearance:
21. Specific purpose for which the material is required, including specific
program/end item

FSC, level and date of clearance
22. Name and address of cognizant DIS security office

23. Applicant's Statement (see instructions)
I,

Typed name

, hereby apply for a license to complete

24. License copy to be sent to: Name, address, ZIP code

6 - APPLICANT

DSP-85

OMB NO. 1405-0022
EXPIRATION DATE: 09-30-2008
ESTIMATED BURDEN: 1 Hour

Page 7 of 7

File Type	application/pdf
File Title	DSP0085.far - Design Mode
Author	dixonjg
File Modified	2008-07-30
File Created	2008-07-11