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

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

DEPARTMENT OF HOMELAND SECURITY

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 146.32, 146.40

3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER

2. PORT CODE

5. IMPORT DATE

4. EXPORT DATE

6. ZONE ADMISSION NO.

7. U.S. PORT OF UNLADING

8. FOREIGN PORT OF LADING

9. BILL OF LADING/AWB NO. 10. INWARD M'FEST 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

17.
HTSUS NO.

16.
DESCRIPTION OF MERCHANDISE

YES
18.
QUANTITY
(HTSUS)

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:
ZONE RESTRICTED
PRIVILEGED FOREIGN
DOMESTIC
NONPRIVILEGED FOREIGN
(19 CFR 146.44)
(19 CFR 146.41)
(19 CFR 146.43)
(19 CFR 146.42)
27. DATE
24. APPLICANT FIRM NAME
26. TITLE
25. BY (Signature)

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

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

Permission is hereby granted to 31. PORT DIRECTOR OF CBP: BY (Signature)
transfer the above merchandise
into the Zone.
The above merchandise has been 34. PORT DIRECTOR OF CBP: BY (Signature)
granted the requested status.
37. The goods described herein are authorized to be transferred:

PERMIT
TO
TRANSFER

38. CBP OFFICER AT STATION (Signature)

29. TITLE

30. DATE

32. TITLE

33. DATE

35. TITLE

36. DATE

without exception

39. TITLE

42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature) 43. CARTMAN

except as noted below

40. STATION

41. DATE

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:
FTZ
OPERATOR'S
REPORT OF
MERCHANDISE
RECEIVED AT
49. DATE
48. TITLE
47. FOR THE FTZ OPERATOR (Signature)
ZONE

(See page 2 for Paperwork Reduction Act Notice.)

STATISTICAL COPY

CBP Form 214A (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 214A (11/09)