Form 7523 Entry and Manifest Free of Duty

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0013
Exp. 12-31-2011

U.S. Customs and Border Protection

ENTRY AND MANIFEST OF MERCHANDISE FREE OF DUTY,
CARRIER'S CERTIFICATE AND RELEASE
1. NO.
19 U.S.C. 1433, 1484, 1498; 19 CFR 123.4, 143.23
The undersigned, as the importer of merchandise described below, which arrived at the port or station identified, hereby claims free entry therefore
under the provisions of the applicable law indicated.
2. PORT CODE

3. DATE

4. VESSEL OR OTHER CONVEYANCE

7.
MARKS AND NUMBERS

8.
DESCRIPTION AND QUANTITY OF MERCHANDISE

11. IMPORTER OF RECORD (Name and Address)

13. INSPECTED AND PASSED FREE OF DUTY BY:

15. SIGNATURE (Inspector)

5. ARRIVAL DATE

6. COUNTRY OF EXPORTATION

9.
VALUE

10.
HTSUS HEADING NO. OR P.L. NO.

12. AGENT'S SIGNATURE

14. OWNER, PURCHASER, OR CONSIGNEE (If different from Importer of Record)

16. DATE

CARRIER'S CERTIFICATE AND RELEASE ORDER

The undersigned carrier, to whom or upon whose order the articles described above must be released, hereby certifies that the person or firm named
above as the importer is the owner purchaser, or consignee of such articles within the purview of section 484(h), Tariff Act of 1930. In accordance
with the provisions of section 484(j), Tariff Act of 1930, authority is hereby given to release the articles to such consignee.
17. CARRIER

18. AGENT'S SIGNATURE

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 1651-0013. 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 7523 (06/09)