SAMPLE IMMIHELP.COM CustomsDeclaration FORMAPPROVED Oil,lB NO.1651-0009 Each arriving traveler or responsiblefamily member must provide the following information (only ONE wriften declaration per family is required): 1. FamilyName 19CFR122.27,148.12, 148.13, 148.110,148.111, 14S8i 31CFR5316 Ftlr.;t (Giorn) 2. Birdr date Middle D^y Month Year 3. Number of Family members traveling with you 4. (a) U.S. Street Address (hotel name/destination) (b) City (c) State 5. Passport issued by (country) 6. Passport number 7. Country of Residence 8. Countries visited on this rip prior to U.S. arrival 9. Airline/Flight No. or Vessel Name 10. The primary purposeof this trip is business: I l. I am (We are) bringing (a) fruits, vegetables,plants, seeds,food, insects: Yes No Yes No (b) meats,animals,animaVwildlife products: Yes No (c) diseaseagents,cell cultures, snails: Yes No (d) soil or have been on a fann/rancVpasture: Yes No 12.I have QV'ehave)been in close proximity of (such as touching or handling) livestock: Yes No I 3. I am (We are) carrying currency or monetary instruments over $10,000 U.S. or foreign equivalent Yes No (seedefinition of monetary instrurnentson reverse) 14.I have (We have)commercial merchandise: Yes No (articlesfor sale,samplesused for soliciting orders, or goods that are not consideredperconaleffects) l5.Residents - the total value of all goods, including commercial merchandise I/we have purchased or acquired abroad, (including gifts for someoneelse,but not items mailed to the U.S.) and amlare bringing to the U.S. is: $ Visitors - the total value of all articles that will remain in the U.S.. including commercial merchandiseis: $ Read the instructions on the back of this form. Soaceis nrovided to list all the items you must declare. I HAVE READ THE IMPORTANTINFORMATIONON THE REVERSESIDE OF THI$ FORM AND HAVE MADE A TRUTHFULDECLARATION. For Official Use Onll' C B P F o r m6 0 5 9 8 ( 0 1 / 0 4 ) U.S.Customsand BorderProtection WelcomesYou to the UnitedStates U.S. Customs and Border Protection is responsible for protecdng the United Statesagainstthe illegal importation of prohibited items. CBP officers have the authority to question you and to examine you and your personal properry. If you are one ofthe travelersselectedfor an examinarion,you will be treated in a courteous, professional,and dignified manner. CBP Supervisorsand Passenger ServiceRepresentativesare availableto answeryour questions.Comment cards are availableto compliment or provide feedback. lmpoitant Information U.S. Residents - declare all articles tiat you have acquired abroad and are bringing into the United States. Visitors (Non-Residents) - declare the value of all articles that will remain in the United States. Declare all articles on this declaration form and show the value in U.S. dollars. For gifis, pleaseindicate the retail value. D.tty - CBP officers will determine duty. U.S. residentsare normally entitled to a duty-free exemption of $800 on items accompanyingthem. Visitors (nonresidents)are normally entided to an exemption of $100. Dury witl be assessed at the current rate on the first $1,000 abovethe exemption. Controlled substances, obscene articles, and toxic substances are generally prohibited entfy. Agriculture products are reefficted entry. Thank You,anil Vlhlccmeto tbe IJniteil Statet. SAMPLE IMMIHELP.COM The transportation of currency or monetary instruments, regardless of the amount, is legal. However, if you bring in to or take out of tle United States more than $10,000(U.S. or foreign equivalent,or a combinationof both), you are required by law to file a report on FinCEN 105 (formerly CustomsForm 4790) with U.S. Customs and Border Protection. Monetary instruments include coin. currency,travelerscheck and bearerinstrumentssuchaspersonalor cashierschecks and stocksand bonds. If you have someoneelse carry the currency or monetary instrument for vou. vou must alsofile a reDort on FinCEN 105. Faiiure to file th! requ.iredreport or ir'il*" to report the tut;l amotrrftthat you.arecarrying may lead to ttre seizureof all the currencyor monetaryinstruments,and may subjectyou to civil penaltiesand/or criminal prosecution.SIGN ON THE OPPOSffE SIDE OF THIS FORA4AFTER YOU TIA\,'E READ THE IIVTPORTI{NT INFOR.N,IAIION ABOVE AND MADE A TRUTHFI]L DECLAMTION. Descriptionof Articles (List may contlnue on another CBP Form 60598) ValUe CBP tlse Only Total PAPERWORK REDUCTION ACf NOTICE: Th6 Paperuod( Aclsaysw musttellyouwhywearemllectingthlsintomation, Reduclion t|o\irlvewill useit, andwhethsyouhaveto giv€il to us.Theinformation colleciedon thisfom is neededto c€rryouttheCustoms, Agticulhire, ad urency lawsof theUnihdStales.CBPrequirestheinfornationon lfiis formto in6urethattravelersaremmplying wih t€s hs andio allowusto figureandmllectlhefightamountof dutyandtax.Yourresponse is mandatoryAnagenclmaynot $rduct s sponw, anda poFonis rct requiFdto 6pond to a coll€clion of infomation, unlessit displays a validoMB6ntml number perrespondent TheestimaHavemgeburdona$miatedwithlhismllectonof infomationis4 minutes or recodkeeperdepending on individulcirdmstances. Comm€nts theamumcyof $is burdenestimate conceming andsuggesllons forrcducing thisburdenshould be directed to U.S.CustonsandBordsrPrdtection, Seryices Dc ReponsClearanm offmr, lnfomation Branch, Washing'ton, 20229,andto theOffceofManagemont Project(1651.0009), andBudget,PapeMo*Reducdon Washington, DC20503.THISFORM I{AYNOTgE REPRODUCED WTHOUTAPPROVAT FROI,ITHECBPFORMSMAI'IAGER 'u.S. G.Po.:2005 - 783-076/80026 CBP Form 60598 (01/04)