Form VS-17-129 APPLICATION FOR IMPORT OR IN TRANSIT PERMIT

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control numbers for these information collections are 0579-0040, 0579-0218, 0579-0224, 0579-0228, 0579-0301, and
0579-0324. The time required to complete this information collection is estimated to average between .16 and .1 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
1. PORT OF ARRIVAL
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB APPROVED
0579-0040, 0579-0218,
0579-0224, 0579-0228
0579-0301, and 579-0324
2. DATE OF ARRIVAL

3. IMPORT PERMIT NUMBERS

DECLARATION OF IMPORTATION
4. COUNTRY OF ORIGIN OF HEALTH CERTIFICATE

(Animals, Animal Semen, Animal Embryos, Birds, Poultry,
or Hatching Eggs)
5. PORT OF EMBARKATION (City, Country)

INSTRUCTIONS: Importer, owner, or authorized agent shall complete an original and
one copy, which shall be presented to Collector of Customs, at port of arrival for
appropriate distribution.

6. CARRIER AND VESSEL OR FLIGHT NUMBER

7. NAME AND ADDRESS OF IMPORTER (Include ZIP Code)

8. NAME AND ADDRESS OF BROKER (If any) (Include ZIP Code and Telephone number)

9. ANIMALS, ANIMAL SEMEN, ANIMAL EMBRYOS, BIRDS, POULTRY, OR HATCHING EGGS
A.

B.

C.

NUMBER

SEX

PURPOSE OF IMPORTATION

(When it can
be determined)

(Dairy, feeding, grazing, breeding, racing, pleasure, slaughter, special breeding*,
hatching, exhibition, propagation, medical, scientific, educational, etc.)

10. NAME AND ADDRESS OF DESTINATION AFTER RELEASE (Include ZIP Code)

I hereby request quarantine or inspection service and agree to reimburse
Veterinary Services or pay in advance for the cost thereof, as may be required, and
waive all claim against Veterinary Services or their employees for damages which
may arise from such service.
The undersigned hereby certifies that the foregoing declaration is true and correct.
11. EXECUTED BY (Signature)

12. TYPE OR PRINT NAME AS SIGNED IN ITEM 11

13. TITLE
Authorized Agent

VS FORM 17-29
NOV 2009

14. DATE
Owner

D.

COMMON NAME
(For domestic livestock or poultry,
show breed and species)

Importer

Previous edition is obsolete.

REMARKS