May–December 1954

[printed: (If this declaration is made by an agent who does not present with the entry the declaration of consignee, or who does not have proper authority to execute such declaration for his principal, bond must be given to produce such declaration, in accordance with section 485 (c), Tariff Act of 1930.)

I, the undersigned, herewith declare that the consignee in whose name this entry is made is not the actual owner of the merchandise covered thereby, but that this entry exhibits a full and complete account of all the merchandise imported or to be imported in the vessel indicated therein by -----------------------------------------------------------------------------------------------------------------, ------------------------------------------------------------------------------------------------------------------------- of -------------------------------------------------------------------------------------------------------------------------------------------------

Printed: (Address)

who is the actual owner for Customs purposes of the said merchandise, except -----------------------------------------------------------------------------------------------------------------------------------------------------------

I also declare, to the best of my knowledge and belief, that all statements appearing in the entry and in the invoice or invoices and other documents presented herewith and in accordance with which the entry is made, are true and correct in every respect; that the entry and invoices set forth the true prices, values, quantities, and all information as required by the laws and the regulations made in pursuance thereof; that the invoices and other documents are in the same state as when received, that I have not received and do not know of any other invoice, paper, letter, document, or information showing a different currency, price, value, quantity, or description of the said merchandise, and that if at any time hereafter I discover any information showing a different state of facts I will immediately make the same known to the Collector of Customs at the port of entry. I further declare, if the merchandise is entered by means of a seller's or shipper's invoice, that no certified invoice for any of the merchandise covered by the said seller's or shipper's invoice can be produced due to causes beyond my control; and that if entered by means of a statement of the value or the price paid in the form of an invoice it is because neither seller's, shipper's, nor certified invoice can be produced at this time.

Date ------------------------------------, 19------

Printed: (Signature)

Printed: (Address)

[printed: Principal. Member of the firm. ----------------------------- of the corporation. (Title) Authorized agent.]

Printed: DECLARATION OF CONSIGNEE OR AGENT FOR MERCHANDISE OBTAINED IN PURSUANCE OF A PURCHASE OR AGREEMENT TO PURCHASE

I, the undersigned, herewith declare that this entry exhibits a full and complete account of all the merchandise imported or to be imported by the consignee in whose name the entry is made in the vessel indicated therein, and that the merchandise was obtained by him in pursuance of a purchase, or an agreement to purchase, except -----------------------------------------

I also declare, to the best of my knowledge and belief, that all statements appearing in the entry and in the invoice or invoices and other documents presented herewith and in accordance with which the entry is made, are true and correct in every respect; that the entry and invoices set forth the true prices, values, quantities, and all information as required by the laws and the regulations made in pursuance thereof; that the invoices and other documents are in the same state as when received, that I have not received and do not know of any other invoice, paper, letter, document, or information showing a different currency, price, value, quantity, or description of the said merchandise, and that if at any time hereafter I discover any information showing a different state of facts I will immediately make the same known to the Collector of Customs at the port of entry. I further declare, if the merchandise is entered by means of a seller's or shipper's invoice, that no certified invoice for any of the merchandise covered by the said seller's or shipper's invoice can be produced due to causes beyond my control; and that if entered by means of a statement of the value or the price paid in the form of an invoice it is because neither seller's, shipper's, nor certified invoice can be produced at this time.

Date ------------------------------------, 19------

Printed: (Signature)

Printed: (Address)

[printed: Principal. Member of the firm. ----------------------------- of the corporation. (Title) Authorized agent.]

[printed: DECLARATION OF CONSIGNEE OR AGENT FOR MERCHANDISE OBTAINED OTHERWISE THAN IN PURSUANCE OF A PURCHASE OR AGREEMENT TO PURCHASE]

I, the undersigned, herewith declare that this entry exhibits a full and complete account of all the merchandise imported or to be imported by the consignee in whose name the entry is made in the vessel indicated therein, and that the merchandise was obtained by him otherwise than in pursuance of a purchase, or an agreement to purchase, except -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

I also declare, to the best of my knowledge and belief, that all statements appearing in the entry and in the invoice or invoices and other documents presented herewith and in accordance with which the entry is made, are true and correct in every respect; that the entry and invoices set forth the true foreign values, prices, quantities, and all information as required by the laws and the regulations made in pursuance thereof; that the invoices and other documents are in the same state as when received, that I have not received and do not know of any other invoice, paper, letter, document, or information showing a different currency, price, value, quantity, or description of the said merchandise, and that if at any time hereafter I discover any information showing a different state of facts I will immediately make the same known to the Collector of Customs at the port of entry. I further declare, if the merchandise is entered by means of a seller's or shipper's invoice, that no certified invoice for any of the merchandise covered by the said seller's or shipper's invoice can be produced due to causes beyond my control; and that if entered by means of a statement of the value or the price paid in the form of an invoice it is because neither seller's, shipper's, nor certified invoice can be produced at this time.

Date ------------------------------------, 19------

Printed: (Signature)

Printed: (Address)

[printed: Principal. Member of the firm. ----------------------------- of the corporation. (Title) Authorized agent.]

Printed: MISSING DOCUMENTS

Printed: NAME AND ADDRESS OF BROKER OR AGENT

[printed: This form may be printed by private parties provided it conforms to official form in size, wording, color, and arrangement. For sale by collectors of customs at price of 35 cents per pad.]

Printed: U. S. GOVERNMENT PRINTING OFFICE 16—17100-9