Sample US Customs Form - Form 6059B for US Customs and

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)