Customs Declaration

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 i a 10 Family Name EfSTE.Tiv First (Given) TaKRe...-y Middle -.-D‘e..c1r.r) Birth date Month O 1 Day 2.O Year 5 3 Number of Family members traveling with you (:::3 (a) U.S. Street Address (hotel name/destination Cj C- fist -1 1st Sircer (b) City Ni GvJ yoRK IC) State Passport issued by (country) Passport number Country of Residence \ *1 IR O f gfr Countries visited on this trip prior to U.S. arrival CR R) ICSfA Airline/Flight No. or Vessel Name IN cezzre The primary purpose of this tr p is business: I am (We are) bringing a) fruits. vegetables, s. nsects: b) meats. anima c) disease s. Cell d) soil or have been on a have (We have) been in c (such Al leuCterg or handling) I am (We are) carrying con over 510.000 U.S. or foreign see Cermayon e monetary nst I hate (We hake) commercial me arttrins for sale. samples used to or goods teat are not considered pet RESIDENTS —tno total value or all I/we have purchased or acquired at 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: es. snails: /ranch/pasture: proximity of rive monetary ins Went: on reverse: MISS: ing OnleIS effects) NY Yes No X Yes No Yes Yes No Yes No It: Yes No y ants Yes No X Yes No y ng cornm ucling 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