Form CBP Form 255 CBP Form 255 Declaration of Unaccompanied Articles

DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection

OMB APPROVAL NO. 1651-0030
EXPIRATION DATE 08/31/2017
ESTIMATED BURDEN 5 MIN

DECLARATION OF UNACCOMPANIED ARTICLES
19 CFR 145.12, 145.43, 148.110, 148.113-148.116
The arriving traveler or head of a family must complete a SEPARATE CBP Form 225 for EACH unaccompanied package or container sent from
American Samoa, Guam, or the U.S. Virgin Islands. PLEASE PRINT the information blocks 1-8 and SIGN block 9.
1. FAMILY NAME

GIVEN NAME

MIDDLE INITIAL

2. NUMBER OF FAMILY MEMBERS
INCLUDED IN FAMILY DECLARATION
4. DATE OF ARRIVAL

3. PERMANENT ADDRESS

5. VESSEL, OR AIRLINE & FLIGHT NO.

6. PORT OF ARRIVAL
7. DESCRIPTION OF ARTICLE(S) IN PACKAGE

8. PRICE

9. I declare that the above articles were acquired in American Samoa, Guam or
the U.S. Virgin Islands by me or those members of my family included in my
declaration. I further declare that the above information is valid and correct to
the best of my knowledge and belief. I will pay any customs duties and internal
revenue taxes which are found to be due upon arrival of the articles.

SIGNATURE X
IMPORTANT
IMPORTER To receive your entitled exemptions and appropriate rates of duty, you must
send the yellow copy of CBP Form 255 to the vendor immediately after
customs validation (Blocks 10 and 11).

VENDOR

1. Enclose this form in an envelope marked "CBP Form 255 enclosed"and
securely attach it to the outside of the package or container.
2. Mark the package or container "Unaccompanied Tourist Shipment."

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- 0030. Obligation to Respond is required
to obtain benefits. The estimated average time to complete this application is 5
minutes. If you have any comments regarding the burden estimate you can write
to U.S. Customs and Border Protection, Office of Trade Regulations and Rulings,
90 K Street, NE., Washington DC 20229.
CBP Form 255 08/17

10. CBP USE ONLY (After arrival of traveler)

11. CBP OFFICE SIGNATURE

DATE

WARNING
FALSE CLAIMS ARE PUNISHABLE BY LAW
CBP USE ONLY (After arrival of article)
12. ARRIVAL DATE
13. MAIL OR INFORMAL ENTRY NO.
14. RELEASE DATE

15. CBP OFFICER

16. DISCREPANCIES BETWEEN CBP FORM 255 AND SHIPMENT

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