214C 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

1. ZONE NO. AND LOCATION (Address)

APPLICATION FOR
FOREIGN-TRADE ZONE ADMISSION
AND/OR STATUS DESIGNATION

2. PORT CODE

CONTINUATION SHEET

6. ZONE ADMISSION NO.

19 CFR 146.32, 146.40
15.
NO. OF
PACKAGES
AND COUNTRY
OF ORIGIN CODE

16.
DESCRIPTION OF MERCHANDISE

(See back of form for Paperwork Reduction Act Notice.)

17.
HTSUS NO.

STATISTICAL COPY

18.
QUANTITY
(HTSUS)

19.
GROSS
WEIGHT

20.
SEPARATE
VALUE & AGGR
CHGS.

CBP Form 214C (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 214C (11/09) (Back)