VS 17-29 Declaration of Importation (Animals, Animal Semen, Anima

Clear Form
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
OMB APPROVED
displays a valid OMB control number. The valid OMB control numbers for these information collections are 0579-0040, 0579-0165, 0579-0228, and 0579-0393. The time
0579-0040, 0579-0165,
required to complete this information collection is estimated to average between .16 and 1 hours per response, including the time for reviewing instructions, searching existing
0579-0228, 0579-0393
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
1. PORT OF ARRIVAL
2. DATE OF ARRIVAL
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

3. IMPORT PERMIT NUMBERS

DECLARATION OF IMPORTATION
4. COUNTRY OF ORIGIN OF HEALTH CERTIFICATE

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

INSTRUCTIONS: Importer, owner, or authorized agent shall complete an original
and one copy, which shall be presented to Collector of Customs, at port of arrival for
appropriate distribution.
7. NAME AND ADDRESS OF IMPORTER (include ZIP code)

5. PORT OF EMBARKATION (city, country)

6. CARRIER AND VESSEL OR FLIGHT NUMBER

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.
COMMON NAME
(for domestic livestock or poultry,
show breed and species)

NUMBER

SEX
(when it can
be determined)

10. NAME AND ADDRESS OF DESTINATION AFTER RELEASE (include ZIP code)

REMARKS

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 claim 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
MAY 2017

14. DATE
Owner

Importer

Previous edition is obsolete.

D.
PURPOSE OF IMPORTATION
(dairy, feeding, grazing, breeding, racing, pleasure, slaughter, special breeding*,
hatching, exhibition, propagation, medical, scientific, educational, etc.)