Form 214 Application for Foreign Trade Zone Admission and/or Stat

DEPARTMENT OF HOMELAND SECURITY

Approved OMB No. 1651-0029 Exp. 06/30/2015

U.S. Customs and Border Protection
APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION

CENSUS USE ONLY

1. ZONE NO. AND LOCATION (Address)

19 CFR 146.22, 146.32, 146.35-146.37, 146.39-146.41, 146.44, 146.53, 146.66
3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER

4. EXPORT DATE

2. PORT CODE

5. IMPORT DATE

6. ZONE ADMISSION NO.

7. U.S. PORT OF UNLADING

8. FOREIGN PORT OF LADING

9. BILL OF LADING/AWB NO.

11. INBOND CARRIER

12. I.T. NO. AND DATE

13. I.T. FROM (Port)

14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT?
15.
NO. OF PACKAGES
AND COUNTRY
OF ORIGIN CODE

16.
DESCRIPTION OF MERCHANDISE

YES
18.
QUANTITY
(HTSUS)

17.
HTSUS NO.

10. INWARD M'FEST NO.

NO
19.
GROSS
WEIGHT

20.
SEPARATE
VALUE & AGGR
CHGS.

21. HARBOR MAINTENANCE FEE (19 CFR 24.24)
22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone. I declare to the best of my knowledge and belief that the above
merchandise is not prohibited entry in the Foreign-Trade Zone within the meaning of section 3 of the Foreign-Trade Zones Act of 1934, as amended,
and section 146.31, Customs Regulations.
23. I hereby apply for the status designation indicated:
NONPRIVILEGED FOREIGN
PRIVILEGED FOREIGN
ZONE RESTRICTED
DOMESTIC
(19 CFR 146.42)
(19 CFR 146.41)
(19 CFR 146.44)
(19 CFR 146.43)
24. APPLICANT FIRM NAME
26. TITLE
27. DATE
25. BY (Signature)

F.T.Z. AGREES TO RECEIVE
MERCHANDISE INTO THE ZONE
PERMIT

Permission is hereby granted to
transfer the above merchandise
into the Zone.

PERMIT

The above merchandise has been
granted the requested status.

28. FOR THE F.T.Z. OPERATOR (Signature)

29. TITLE

30. DATE

31. PORT DIRECTOR OF CBP: BY (Signature)

32. TITLE

33. DATE

34. PORT DIRECTOR OF CBP: BY (Signature)

35. TITLE

36. DATE

37. The goods described herein are authorized to be transferred:

PERMIT
TO
TRANSFER

FTZ
OPERATOR'S
REPORT OF
MERCHANDISE
RECEIVED AT
ZONE

without exception

except as noted below

38. CBP OFFICER AT STATION (Signature)

39. TITLE

40. STATION

41. DATE

42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature)

43. CARTMAN

44. CHL NO.

45. DATE

46. To the Port Director of CBP: The above merchandise was received at the Zone on the date shown except as noted below:

47. FOR THE FTZ OPERATOR (Signature)

(See page 2 for Paperwork Reduction Act Notice.)

48. TITLE

Previous Editions are Obsolete

49. DATE

CBP Form 214 (11/09)

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 1651-0029. The estimated average time to
complete this application is 15 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 214 (11/09)