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OMB APPROVAL NO. 1405-0023
EXPIRATION DATE: 09-30-2008
*ESTIMATED BURDEN: 1 HOUR
* PAPERWORK REDUCTION ACT STATEMENT: 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: Department of State (A/RPS/DIR) Washington, D.C. 20520
U.S. DEPARTMENT OF STATE
DIRECTORATE OF DEFENSE TRADE CONTROLS
APPLICATION/LICENSE FOR TEMPORARY EXPORT OF
UNCLASSIFIED DEFENSE ARTICLES
*Transaction Number:
Please note that an Asterisk (*) next to a field or block in a document designates a mandatory field or block.
No classified information can be included in this application. Classified information must be sent
separately to PM/DDTC in accordance with the Defense Security Service guidelines.
Classified information is being sent under separate cover
To open a document, click on a document to highlight it and select the "Open Document" button. The document that
you selected will open.
Required Documents
Included Documents
DSP-73
Optional Documents
22 CFR § 126.13 Certification Letter
22 CFR § 127.11 Exception to Policy Letter
Firearms and Ammunitions Import Permit
Firearms and Ammunitions Letter of Explanation
Manufacturer Unknown Letter of Explanation
Other Amplifying Data (e.g. Briefing, Proposals)
Precedent (identical/similar) Cases
Product Brochures
Supplementary Explanation of Transaction (e.g. White Paper)
Technical Drawings, Schematics, or Blue Prints
DSP-73
U.S. DEPARTMENT OF STATE
DIRECTORATE OF DEFENSE TRADE CONTROLS
By selecting the "Submit" button, above, the Applicant hereby warrants the truthfulness of
all statements made herein and in accompanying documentation; acknowledges and understands
that, in accordance with 22 C.F.R. §127.2, it is unlawful to use any export or temporary
import control document containing a false statement or misrepresenting or omitting a
material fact for the purpose of exporting any defense article or technical data or the
furnishing of any defense service for which a license or approval is required by this
subchapter and that any false statement, misrepresentation, or omission of material fact in
an export control or temporary import control document will be considered as made in a
matter within the jurisdiction of a department or agency of the United States for the
purposes of 18 U.S.C. 1001, 22 U.S.C. 2778 and 22 U.S.C. 2779; and that the applicant
further agrees to comply with all applicable provisions of 22 C.F.R. §120-130.
To cancel this submission, select "Cancel".
(If you cancel the submission, you will return to the previous page.)
Please be further advised, that if the "Submit" button is not active and you have already saved the
submission, you may not have completed all of the required fields. As a reminder you must save the
submission before you can submit.
Errors
1
DSP-73, Page
of
4
SEAL
Signature
DATE ISSUED
License is hereby granted to the applicant for the described commodity to depart from
the United States for temporary export and return to the United States. This license
may be revoked, suspended or amended by the Secretary of State without prior notice
whenever the Secretary deems such action advisable.
LICENSE VALID FOR
LICENSE NO.
MONTHS FROM ABOVE DATE
UNITED STATES OF AMERICA DEPARTMENT OF STATE
APPLICATION/LICENSE FOR TEMPORARY EXPORT OF
UNCLASSIFIED DEFENSE ARTICLES
*1. Date Prepared *2. PM/DDTC
Applicant/Registrant Code
03/18/2008
*3. Select One:
*4. Specific countries
of sojourn
Single departure and return
Series of departures and returns
5. Applicant's Name, Address, ZIP Code and Telephone Number
*Applicant is:
Government
Manufacturer
Exporter
*6. Probable port of
exit from U.S.
*7. Probable port of
entry into U.S.
Subsidiary
*Name
*Attention
*8. Probable date of first exit from U.S.
mm/dd/yyyy
*9. Probable date of final entry into U.S.
mm/dd/yyyy
10a. Name and telephone numbers of individual(s) to contact if U.S.
Government needs additional information.
*Address
*Name
Ext
*Telephone #
*City
Add
*ZIP Code
*State
Ext
*Telephone #
10b. Name, agency and telephone numbers of U.S. Government
personnel (not PM/DDTC) familiar with the commodity.
Name
Ext
Telephone #
Agency
Add
*11. Description of Transaction
A. This application represents:
ONLY completely new shipment
ONLY renewal of previously issued license no.
B. This application has related license no(s):
*C. This application is related to a disclosure filed with Defense Trade Controls
No
Yes
Enter Compliance Disclosure Number:
Line *12. Quantity
Item
#
Unit Type
1
*13. Commodity
*14. USML Category Number
Category
Commodity Code
*15. $ Value
Unit Price
Add
Sub
Line Item Total
*16. Total Value (Sum of All Pages) $
DSP-73, Page
17. Manufacturer of Commodity
Same as Block 5
18. Name and address of foreign intermediate consignee
Unknown
None
*Name
*Name
*Address
*Address
*City
*City
State
ZIP Code
*Country
*Role
*Country
Add
Add
19. Source of Commodity
Same as Block 5
20. Name and address of temporary foreign consignee
Same as Block 17
None
*Name
*Name
*Address
*Address
*City
*City
State
ZIP Code
*Country
*Country
Add
Add
21. Name and address of consignor and/or freight forwarder in
United States
Same as Block 5
22. Name and address of temporary foreign end-user
Same as Block 20
*Name
*Name
*Address
*Address
*City
*City
*State
*Country
*ZIP Code
Add
Add
*23. Specific purpose of temporary export
Request for Prior Approval (22 CFR § 126.8)
*24. Is the article being exported an Aircraft or Vessel?
Yes
No
Note: Blocks 25 - 29 are on another page and are only
displayed if there is a "Yes" response to Block 24.
2
of
4
DSP-73, Page
3
of
4
DSP-73
* 30. Applicant's statement
I,
an empowered official, (22 CFR § 120.25) or an official of a foreign government entity in the U.S., hereby apply for a license to complete the
transaction 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.
I am authorized 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
*22 CFR § 126.13 Certification (Select one)
a. I am authorized by the applicant to certify that the applicant and all of the parties to the transaction can meet in full the conditions of 22 CFR
§ 126.13 as listed above.
b. I am authorized by the applicant to certify to 22 CFR § 126.13. The applicant or one of the parties of the transaction cannot meet one or
more of the conditions of 22 CFR § 126.13 as listed above. A request for an exception to policy, as described in Section 127.11 of the ITAR, is
attached.
c. I am authorized by the applicant to certify to 22 CFR § 126.13. The applicant or one of the parties of the transaction cannot meet one or
more of the conditions of 22 CFR § 126.13 as listed above. However that party has met the conditions imposed by the Directorate of Defense
Trade Controls in order to resume standard submission of applications, not requiring an exception to policy as described in Section 127.11 of the
ITAR.
d. I am not authorized by the applicant to certify the conditions of 22 CFR § 126.13 as listed above. The applicant and all of the parties to the
transaction can meet in full the conditions of 22 CFR § 126.13 as listed above. Please see the attached letter from an official that is authorized by
the applicant to certify to the conditions of 22 CFR § 126.13.
e. I am not authorized by the applicant to certify the conditions of 22 CFR § 126.13 as listed above. The applicant or one of the parties of the
transaction cannot meet one or more of the conditions of 22 CFR § 126.13 as listed above. A request for an exception to policy, as described in
Section 127.11 of the ITAR, and a letter from an official that is authorized by the applicant to certify to the conditions of 22 CFR § 126.13 are
attached.
f. I am not authorized by the applicant to certify the conditions of 22 CFR § 126.13 as listed above. The applicant or one of the parties of the
transaction cannot meet one or more of the conditions of 22 CFR § 126.13 as listed above. However that party has met the conditions imposed by
the Directorate of Defense Trade Controls in order to resume standard submission of applications, not requiring an exception to policy as
described in Section 127.11 of the ITAR. Please see the attached letter from an official that is authorized by the applicant to certify to the
conditions of 22 CFR § 126.13.
Signature
Signature
31. License to be sent to:
[Block is inactive on electronic form.]
Name
Address
City
State
Telephone #
ZIP Code
Ext
DSP-73, Page
4
of
4
CONDITIONS OF ISSUANCE AND TEMPORARY EXPORT PROCEDURES
1. This license is issued under the conditions cited in 22 CFR 120-130, including provisos as applicable to a specific license authorization.
2. Approval of this license shall not be construed as implying U.S. Government approval or commitment to authorize future exports of any defense article on
the U.S. Munitions List (USML) or any U.S. Government commitment with regard to any proposed manufacturing license, technical assistance or distribution
agreement that may result from a license authorization.
3. The issuance of a license for the export of hardware does not authorize the export of any technical data, unless covered by an exemption.
4. The issuance of this license does not release the applicant, or anyone acting on its behalf, from complying with other requirements of U.S. law and
regulations.
5. No transfer of title is authorized to occur during the period of temporary export from the United States and access to the defense article by foreign persons
shall only be in accordance with and for the purpose identified on the license.
6. Licenses for the temporary export of an aircraft or vessel: The applicant when using this license agrees that during its sojourn abroad (1) the aircraft/vessel
will remain demilitarized or has only those capabilities that are subject of this license, (2) the applicant will maintain a valid U.S. certification or registry, (3) the
aircraft/vessel will not be used in military activites, and (4) it will be operated only by a United States licensed operator (except during U.S. Government
approved demonstrations). Also, during its sojourn abroad, the commander will not transport in the aircraft/vessel any defense articles (e.g., arms, ammunitions
or implements of war) as described in the U.S. Munitions List unless authorized in this license or by a separate license or exemption under appropriate U.S.
Government regulations.
7. The prior written approval of the Department of State, Directorate of Defense Trade Controls, must be obtained before USML articles exported from the
United States using a license or other approval, to include an ITAR exemption, may be resold, transferred, diverted, transshipped, reshipped, re-exported to, or
used in any country, or by any end user or for any end use, other than that described on the license or other approval.
8. The equipment authorized for temporary export may be shipped only from a U.S. port where a U.S. Customs and Border Protection officer is available. It
may not be shipped on any vessel, aircraft or other means of conveyance that is owned or operated by, or leased to or from, any of the proscribed countries or
areas. The applicant retains the original of the license. Prior to each export or entry the applicant presents the original of the license to a U.S. Customs and
Border Protection officer for verification and endorsement, having declared the export or entry in accordance with the ITAR and U.S. Customs and Border
Protection procedures using the Automated Export System (AES). When a license is authorized for the temporary export of an aircraft and vessel, in addition
to presenting the license for verification and endorsement, the exporter must carry the U.S. Customs and Border Protection endorsed license on board as
evidence of proper export authorization. Any article temporarily exported must be returned to the United States prior to expiration of the license or the
applicant must request a new license at least 60 days prior to the expiration date to renew the authorization. In any instance when a request for renewal is not
granted the exporter must immediately return the articles to the United States.
RETURN OF LICENSE
This license must be returned in accordance with 22 CFR 123 to 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 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
QUANTITY
COMMODITY (Include 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.
Aircraft or Vessel Page
of
0
DSP-73, Page
Aircraft or Vessel Information
of
Aircraft or Vessel Information #
25. FAA Reg. No., or Vessel Document Number of aircraft or vessel, and vessel name
*26. Date of FAA. Reg. No. or Vessel
Document Number
*FAA Reg. # or Vessel
Document #
mm/dd/yyyy
Vessel name
27. Make, model, and serial no. of aircraft or vessel
28. Physical location of the aircraft or vessel
*Make
*Address
*Model
*Serial
no.
*City
State
ZIP Code
*Country
29. Aircraft or vessel commander name, operator or certification license no, address, and ZIP code
1
*Commander
name
*Address
*City
*Operator or Cert.
license no.
State
ZIP Code
*Country
*Telephone #
2
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
3
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
4
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
5
Commander
name
Address
City
Operator or Cert.
license no.
State
Country
Telephone #
Add Additional Commanders
ZIP Code
4
Additional Commanders Page
of
DSP-73, Page
Additional Commanders
Aircraft or Vessel Information #
-1 Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
0
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
1
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
2
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
3
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
4
Commander
name
Address
City
Operator or Cert.
license no.
State
ZIP Code
Country
Telephone #
5
Commander
name
Address
City
Operator or Cert.
license no.
State
Country
Telephone #
ZIP Code
of
4
DSP-73, Page
Subsidary Information under Block 5, Page 1 of the DSP-73
*Name
*Attention
*Address
*City
*State
*Telephone #
*ZIP Code
Ext
of
4
Description of Transaction
Continuation to Block 11
A. This application represents only renewal of previously issued license no.
B. This Application has related license no(s)
NOTE: You must first select the appropriate check boxes under this section to add license no(s)
was licensed to the country in Block 4 of the first page under license no(s)
was licensed to other countries under license no(s)
was returned without action under voided license no(s)
was denied to the country in Block 4 of the first page under voided license(s)
DSP-73, Page
of
4
Additional Commodities Page #
Line 12. Quantity
Item
#
of
0
13. Commodity
DSP-73, Page
Additional Commodities
of
4
14. USML Cat. Number
Category
Commodity Code
Sub
-1
Unit Type
15. $ Value
Unit Price
Line
Item
#
12. Quantity
13. Commodity
Line Item Total
14. USML Cat. Number
Category
Sub
Commodity Code
0
15. $ Value
Unit Type
Unit Price
Line
Item
#
12. Quantity
13. Commodity
Line Item Total
14. USML Cat. Number
Category
Sub
Commodity Code
1
Unit Type
15. $ Value
Unit Price
TOTAL VALUE
Line Item Total
$
0
Additional Contacts Information
of
DSP-73, Page
0
Additional Applicant Contact Information
Name
Name
Telephone #
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Telephone #
Ext
Telephone #
Ext
Telephone #
Ext
Telephone #
Ext
Telephone #
Ext
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Name
Name
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Name
Name
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Name
Name
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Name
Name
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Name
Name
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Name
Name
Telephone #
Ext
Name
Name
Telephone #
Telephone #
Ext
Telephone #
Ext
of
4
Additional Familiar Information
of
of
DSP-73, Page
0
Additional Contacts Familiar with Commodity Information
Name
Telephone #
Name
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Ext
Telephone #
Agency
Agency
Name
Name
Telephone #
Agency
Ext
Telephone #
Agency
Ext
Ext
Ext
Ext
Ext
Ext
Ext
Ext
4
Additional Foreign End User Page #
of
0
DSP-73, Page
Additional Temporary Foreign End Users
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
of
4
Additional Manufacturers Page #
of
0
Additional Manufacturers of Commodities
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
Country
ZIP Code
State
Country
DSP-73, Page
ZIP Code
ZIP Code
ZIP Code
ZIP Code
ZIP Code
of
4
Additional Foreign Consignee Page #
of
0
DSP-73, Page
Additional Temporary Foreign Consignee
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
Name
Name
Address
Address
City
City
Country
Country
of
4
Additional Sources Page #
of
0
Additional Sources of Commodities
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
ZIP Code
State
Country
Country
Name
Name
Address
Address
City
City
State
Country
ZIP Code
State
Country
DSP-73, Page
ZIP Code
ZIP Code
ZIP Code
ZIP Code
ZIP Code
of
4
Additional Foreign Intermediate
Consignees Page #
of
0
Additional Foreign Intermediate Consignees
Name
Name
Address
Address
City
City
Country
Country
Role
Role
Name
Name
Address
Address
City
City
Country
Country
Role
Role
Name
Name
Address
Address
City
City
Country
Country
Role
Role
Name
Name
Address
Address
City
City
Country
Country
Role
Role
DSP-73, Page
of
4
Additional Consignors Page #
of
0
DSP-73, Page
Additional Consignors in United States
Name
Name
Address
Address
City
City
State
ZIP Code
State
Name
Name
Address
Address
City
City
State
ZIP Code
State
Name
Name
Address
Address
City
City
State
ZIP Code
State
Name
Name
Address
Address
City
City
State
ZIP Code
State
Name
Name
Address
Address
City
City
State
ZIP Code
State
Name
Name
Address
Address
City
City
State
ZIP Code
State
ZIP Code
ZIP Code
ZIP Code
ZIP Code
ZIP Code
ZIP Code
of
4
Full View of Description
Item #23 of the DSP-73
DSP-73, Page
4
of
4
Complete List of Countries under Block 4, Page 1 of the DSP-73
Total Number of Countries Selected as Specific countries of Sojourn: 0
DSP-73, Page
4
of
4
Attachments pertaining to Letter of Explanation (Explanation of complicated cases)
Attachment?:
Add Attachments
Preferred attachment file type is PDF searchable.
Remove Attachments
View Attachments
Attachments pertaining to Firearms and Ammunitions Import Permit
Attachment?:
Add Attachments
Preferred attachment file type is PDF searchable.
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Attachments pertaining to Firearms and Ammunitions Letter of Explanation
Attachment?:
Add Attachments
Preferred attachment file type is PDF searchable.
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Attachments pertaining to Other Amplifying Data (e.g. Briefing, Proposals)
Attachment?:
Add Attachments
Preferred attachment file type is PDF searchable.
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Attachments pertaining to Precedent (identical/similar) Cases
Attachment?:
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Preferred attachment file type is PDF searchable.
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Attachments pertaining to Product Brochures
Attachment?:
Add Attachments
Preferred attachment file type is PDF searchable.
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Attachments pertaining to Supplementary Explanation of Transaction (e.g. White Paper)
Attachment?:
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Attachments pertaining to Technical Drawings, Schematics, or Blue Prints
Attachment?:
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Preferred attachment file type is PDF searchable.
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Attachments pertaining to 22 CFR § 127.11 Exception to Policy Letter
Attachment?:
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Attachments pertaining to 22 CFR § 126.13 Certification Letter
Attachment?:
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Preferred attachment file type is PDF searchable.
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Attachments pertaining to Manufacturer Unknown Letter of Explanation
Attachment?:
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Preferred attachment file type is PDF searchable.
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View Attachments
Are you sure you want to delete this page?
To continue and delete selection, select "YES". To cancel delete, select "NO".
After the page has been deleted, you will be automatically returned to the previous continuation
page (if you have 2 or more continuation pages) or to the main page for the Block for which the
additional page was added (if you have only one continuation page).
YES
NO
Are you sure you want to delete this page?
To continue and delete selection, select "YES". To cancel delete, select "NO".
After the page has been deleted, you will be automatically returned to the previous continuation
page (if you have 2 or more continuation pages) or to the main page for the Block for which the
additional page was added (if you have only one continuation page).
YES
NO
| File Type | application/pdf |
| File Title | H:\Documents\sample_dsp-73_v2.0.xfdl |
| Author | lunsfordtr |
| File Modified | 2008-03-18 |
| File Created | 2008-03-18 |