EFTA00313939.pdf

Customs Declaration FONEAPPINIC If Mt Mix NW. 148.1114m)(04siti. lift U M Sno ea ea letaa Each arriving traveler or responsible family member must provide the !Wowing information (only ONE written declaration per family is required). The term 'family' is defined as -members of a family residing in the same household who are related by blood, marriage, domestic relationship. or adoption. O Family Name First (Given) Birth date EfSTE.Tiv TaKRe...-y Month O 1 Day 2.O Year 5 3 Middle --D‘e..c1r.r) . Number of Family members traveling with you (:::3 (a) U.S. Street Address (hotel name/destination Cj C- fist -11st Sircer (b) City Ni GvJ yoRK Passport issued by (country) IC) State NY Passport number Country of Residence \ *1IR O f gfr Countries visited on this trip prior to U.S. arrival CR R) ICSfA i a Airline/Flight No. or Vessel Name IN cezzre 10 The primary purpose of this tr p is business: Yes No X I am (We are) bringing a) fruits. vegetables, s. nsects: Yes No b) meats. anima Yes c) disease s. Cell es. snails: Yes No d) soil or have been on a /ranch/pasture: Yes No have (We have) been in c (such Al leuCterg or handling) proximity of rive It: Yes No y I am (We are) carrying con over 510.000 U.S. or foreign monetary ins Went: ants Yes No X see Cermayon e monetary nst on reverse: I hate (We hake) commercial me arttrins for sale. samples used to MISS: ing OnleIS Yes No y or goods teat are not considered pet effects) RESIDENTS —tno total value or all ng cornm I/we have purchased or acquired at ucling hut not items mailed to the U.S.) a bringing to the U.S. is: VISITORS —the total value of al artie will remain in the U.S., including commercial Ise Is: Read the instructions on the back oft form. Space is provided to list all the items you must declare. I HAVE READ Ma nereETAIIT INIECOMATION OW flit eavaina Slot Pella FORM Amp HAVE MADE A TIMITIOUL DECLAAATION. Severe Dee feeehletervsee cs Form 60598(04/u) EFTA00313939