DEPARTMENT OF HOMELAND SECURITY

DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection FORM APPROVED OMB NO. 1651.0014 Exp. 06-30-2016 DECLARATION FOR FREE ENTRY OF UNACCOMPANIED ARTICLES 19 CFR 148.6, 148.52, 148.53, 148.77 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 1651-0014 The estimated average time to complete this application is 45 minutes. If you have any comments regarding the burden estimate you can wnte to U.S. Customs and Border Protection. Office of Regulations and Rulings. 799 9th Street. NW . Washington DC 20229 PART — TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES (Please consult with the CBP official for add Tonal information or assistance REMEMBER-All of your statements are subject to verification False declarations or failure to declare articles could result in penalties.) 1. IMPORTERS NAME (Last, first and middle) 3. IMPORTERS DATE OF ARRIVAL 2. IMPORTER'S DATE OF BIRTH Lesley Groff June 1 1 , 2019 1 0-1 4 -6 6 4. IMPORTERS U.S. ADDRESS 9 East 71st Street, NY, NY 10021 5 IMPORTER'S PORT OF ARRIVAL Teterboro Airport 6. NAME OF ARRMNG VESSEL CARRIER AND FLIGHT/TRAIN Private Plane TaiL#N212JE 7. NAME(S) OF ACCOMPANYING HOUSEHOLD MEMBERS (wife, husband, minor children. etc) 8. THE ARTICLES FOR WHICH FREE ENTRY IS CLAIMED BELONG TO ME AND/OR MY FAMILY AND WERE IMPORTED E. NUMBER AND KINDS OF CONTAINERS 1 A. DATE Junell,'19 B. NAME OF VESSEL/CARRIER Federal Express F. MARKS AND NUMBERS C. FROM (County) USV: D. BA. OR AVVB OR I.T. NO. PART II - TO BE COMPLETED BY ALL PERSONS EXCEPT U.S. PERSONNEL AND EVACUEES 9. RESIDENCY (*X" appropriate box) I declare that my place of residence abroad O is 0 was C. RESIDENCY STATUS UPON MY/OUR ARRIVAL C' One) El (1) Returning resident of the U.S. (2) Nonresident: 10. STATEMENT(S) OF ELIGIBILITY FOR FREE ENTRY OF ARTICLES I the undersigned further declare that ("X" all applicable Items and submit packing list): A. Applicable to RESIDENT and NONRESIDENT O (1) AU household effects acquired abroad for which free entry is sought were used abroad brat least one year by me or my family in a household of which I or my family was a resident member dunng such period of use. and are not intended for any other person or for sale. I A NAME OF COUNTRY B LENGTH OF TIME USVI June 3-11,2019 Yr. Mo O a. Emigrating to the U.S. K b. Visaing the U.S. C. Applicable to NONRESIDENT ONLY O(1) All household effects acquired abroad for which free entry is sought were used abroad for at least one year by me or my family in a household of which I or my family was a resident member during such period of use, and are not intended for any other person or for (9804.00.05, 0(2) All instruments. implements, or tools Of trade, occupation or enthyment O (2) Any vehicles, trailers, bicycles or other means of conveyance being and all professional books for which free entry is sought were imported are br the transport of me and my family and such incidental abroad by me or for my account or I am an emigrant who owned and carnage of articles as are appropriate to my personal use of the used them abroad. (9804.00 10,9804.00.15, HTSUSA) conveyance. (9804.00.35, HTSUSA) B. Applicable to RESIDENT ONLY 0 Al personal effects for which free entry is sought wens taken abroad by me or for my account. (9804.00.45. HTSUSA) PART III — TO BE COMPLETED BY U.S. PERSONNEL AND EVACUEES ONLY I. the undersigned, the owner. importer, or agent of the importer of the personal and household effects for which free entry is claimed. hereby certify that they were in direct personal possession of the importer, or of a member of the importer's family residing with the importer. while abroad, and that they were imported into the United States because of the termination of assignment to extended duty (as defined in section 148.74(d) of the Customs Regulations) at a post or station outside the United States and the CBP Territory of the United States or because of Government orders or instructions evacuating the importer to the United States, and that they are not imported for sale or for the account of any other person and that they do not include any alcoholic beverages or agars. Free entry for these effects is claimed under Subheading No. 9805 00.50. Harmonized Tariff Schedule of the United States. 1. DATE OF IMPORTERS LAST DEPARTURE FROM THE U.S. 2. A COPY OF THE IMPORTER'S TRAVEL ORDERS IS ATTACHED AND THE ORDERS WERE ISSUED ON: PART IV — TO BE COMPLETED BY ALL PERSONS SEEKING FREE ENTRY OF ARTICLES (Certain articles may be subject to duty and/or other requirements and must be specific:0y declared herein Please check all applcable items and list them separately in item Don the reverse.) A. For U.S. Personnel, Evacuees, Residents and Non-Residents K (1) Articles for the account O (2) Articles for sale or of other person. 0:61111erClal use. K (3) Firearms and/or O (4) Alcoholic articles of as ammunition. types or tobacco products. O (5) Fruits, plants, seeds, meats, or birds. O (6) Fish, wildlife, animal products thereof. B. For Residents and Non•Residents ONLY O (7) Foreign household effects O (8) Foreign household effects acquired abroad and used less acquired abroad and used more than one year. than one year. C. For Resident ONLY O (9) Personal effects acquired abroad 0(10) Foreign made articles acquired in the United States and taken abroad on this hip or acquired abroad on another tnp that was previously declared to C(1l) Articles taken abroad for which alterations or repairs were performed abroad CBP Form 3299 (10/09) EFTA00314124