Form 6043 delivery ticket

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
DELIVERY TICKET

Form Approved OMB No. 1651-0081 Exp. 05-31-2016
PORT

ENTRY NUMBER (IT, G.O., Detention, SZ, Other, Describe)

19 CFR 4.34, 4.37, 19.9; 19 USC 1551a, 1565
TRANSFER

CARTAGE

RELEASE

GOODS DELIVERED TO
DATE OF ENTRY

GOODS DELIVERED FROM (Pier, Station, Airport, etc.)

DATE OF ARRIVAL
NAME AND ADDRESS OF CONSIGNEE

AIR WAYBILL OR BILL OF LADING NO.
NAME OF IMPORTING CARRIER (If Airline, Give Airline and Flt. No.)
LIEN NO.

DATE OF LIEN

LIEN FILED BY

LIEN SATISFIED (19 USC 1564)
DATE
MARKS AND NUMBERS
CONT. NUMBER, PIECE COUNT

ENTRY

DESCRIPTION OF MERCHANDISE

SALE

DESTROYED

CONDITION, WEIGHTS, ETC.

TOTAL NO. OF PACKAGES / UNITS SIGNATURE OF CONSIGNEE

Delivered in good condition except as noted

Received in good condition except as noted

QUANTITY DISCREPANCIES NOTE HERE:
VEHICLE LICENSE PLATE NUMBER

CUSTODIAL BOND NUMBER OF DELIVERING PARTY (19 CFR 113.63)

C.H. LICENSE NUMBER

TRUCK NUMBER

DELIVERING CBP OFFICER

DATE

DELIVERING PROPRIETOR

COMPANY NAME AND SIGNATURE OF CARTMAN/ LIGHTERMAN/
COMMON CARRIER
TIME

RECEIVING CBP OFFICER

DATE

TIME

RECEIVING PROPRIETOR

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
1651-0081. The estimated average time to complete this application is 20 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 6043 (08/11)