Free CBP Form 214A - Application for Foreign-Trade Zone Admission and/or Status Designation - Federal

DEPARTMENT OF HOMELAND SECURITY
CENSUS USE ONLY

OMB No. 1651-0029 Exp. 01-31-2010

U.S. Customs and Border Protection APPLICATION FOR FOREIGN-TRADE ZONE ADMISSION AND/OR STATUS DESIGNATION
19 CFR 146.32, 146.40 4. EXPORT DATE

1. ZONE NO. AND LOCATION (Address)

2. PORT CODE 5. IMPORT DATE 6. ZONE ADMISSION NO.

3. IMPORTING VESSEL (& FLAG)/OTHER CARRIER 7. U.S. PORT OF UNLADING 11. INBOND CARRIER

8. FOREIGN PORT OF LADING 12. I.T. NO. AND DATE

9. BILL OF LADING/AWB NO. 10. INWARD M'FEST NO. 13. I.T. FROM (Port) YES 18. QUANTITY (HTSUS) NO 19. GROSS WEIGHT 20. SEPARATE VALUE & AGGR CHGS.

14. STATISTICAL INFORMATION FURNISHED DIRECTLY TO BUREAU OF CENSUS BY APPLICANT? 15. NO. OF PACKAGES AND COUNTRY OF ORIGIN CODE 16. DESCRIPTION OF MERCHANDISE 17. HTSUS NO.

21. HARBOR MAINTENANCE FEE (19 CFR 24.24) 22. I hereby apply for admission of the above merchandise into the Foreign-Trade Zone. I declare to the best of my knowledge and belief that the above merchandise is not prohibited entry in the Foreign-Trade Zone within the meaning of section 3 of the Foreign-Trade Zones Act of 1934, as amended, and section 146.31, Customs Regulations. 23. I hereby apply for the status designation indicated: ZONE RESTRICTED PRIVILEGED FOREIGN DOMESTIC NONPRIVILEGED FOREIGN (19 CFR 146.44) (19 CFR 146.41) (19 CFR 146.43) (19 CFR 146.42) 27. DATE 24. APPLICANT FIRM NAME 26. TITLE 25. BY (Signature)

F.T.Z. AGREES TO RECEIVE MERCHANDISE INTO THE ZONE PERMIT PERMIT

28. FOR THE F.T.Z. OPERATOR (Signature)

29. TITLE 32. TITLE 35. TITLE

30. DATE 33. DATE 36. DATE except as noted below

Permission is hereby granted to 31. PORT DIRECTOR OF CBP: BY (Signature) transfer the above merchandise into the Zone. The above merchandise has been 34. PORT DIRECTOR OF CBP: BY (Signature) granted the requested status. 37. The goods described herein are authorized to be transferred:

without exception

PERMIT TO TRANSFER

38. CBP OFFICER AT STATION (Signature)

39. TITLE

40. STATION 44. CHL NO.

41. DATE 45. DATE

42. RECEIVED FOR TRANSFER TO ZONE (Driver's Signature) 43. CARTMAN

46. To the Port Director of CBP: The above merchandise was received at the Zone on the date shown except as noted below: FTZ OPERATOR'S REPORT OF MERCHANDISE RECEIVED AT 49. DATE 48. TITLE 47. FOR THE FTZ OPERATOR (Signature) ZONE

(See page 2 for Paperwork Reduction Act Notice.)

STATISTICAL COPY

CBP Form 214A (08/00)

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to carry out the laws and regulations administered by U.S. Customs and Border Protection and Foreign-Trade Zones Board. These regulations and forms apply to importers/exporters to ensure that they are complying with these laws. It is mandatory. The estimated average burden associated with this collection of information is 15 minutes per respondent and depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should bedirected to U.S. Customs and Border Protection, Information Services Branch, Washington DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0029), Washington, DC 20503.

CBP Form 214A (08/00)