VS 17-29 Declaration for Importation

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 this information collection are 0579-0040, 0579-0218, 0579-0224, 0579-0228,
0579-0301,0579-0324, and 0579-XXXX. The time required to complete this information collection is estimated to average between .16 and 1 hour 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.
UNITED STATES DEPARTMENT OF AGRICULTURE
1. PORT OF ARRIVAL
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

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

3. IMPORT PERMIT NUMBERS

DECLARATION FOR IMPORTATION
(Animals, Animal Semen, Animal Embryos, Birds, Poultry, or Hatching Eggs)

4. COUNTRY OF ORIGIN OF HEALTH CERTIFICATE

5. PORT OF EMBARKATION (City, Country)

No animals, animal semen, animal embryos, birds, poultry or hatching eggs may be
imported unless a completed application has been received (9 CFR 92, 93, 94 and 98).
INSTRUCTIONS: Importer, owner, or authorized agent will complete an original and one copy which will be
presented to the 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

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

(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 claims 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

Importer
Previous edition is obsolete.

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