Free Form Approved OMB No - Federal

U.S. Customs and Border Protection RECORD OF VESSEL FOREIGN REPAIR OR EQUIPMENT PURCHASE
2. Owner Name 19 CFR 4.7, 4.14 Address Address 5. IMO No.

DEPARTMENT OF HOMELAND SECURITY

1. Function of this document (Check one) DECLARATION
(Complete items 1-17 and 20-26)

19. Entry Number

OMB Approved No. 1651-0027 Expires 06/30/2011

ENTRY

20. Principal Name Importer No. Address

(Complete items 1-16 and 20-28; 19 if available)

Phone Phone 6. Name of Master 8. Last U.S. Departure Date

3. Represented Locally By: Name 4. Vessel Name 7. Last U.S. Departure Port 9. Foreign Port Arrived From

Phone No. 21. Surety Name and Number 22. Bond: Single Transaction Continuous Bond No. 24. Exchange Rate 25. Entered U.S. cost 26. Duty @ 50% Entered Cost in U.S. Money 23. Bond Amt.

10. Voyage No.

11. U.S. Port of Arrival

12. Port Code

13. Arrival Date 16. Cost in foreign Money

14. Location (City and Country) and Sailing Date from that Country

15. Description of Work Performed Including Identification of Materials/Equipment Purchased

17. CERTIFICATION OF MASTER

ITEMS BELOW FOR DECLARATION ONLY, DO NOT USE FOR ENTRY

27. TOTAL AMOUNT DECLARED

28. CERTIFICATION OF MASTER OR AUTHORIZED AGENT OF THE OWNER
I hereby subscribe to the statement relative to an entry on the back of this document. Check one: A. Full and Complete B. Incomplete

As Master of the said vessel, I hereby subscribe to the declaration statement on the back of this document.

I have examined the vessel's log, which indicates: The undeclared repairs or purchases which I have listed on the back of this declaration; No undeclared repairs or purchases. Vessel not boarded; Log not examined.

18. CBP USE ONLY

17A. Signature 17B. Title 17C. Date

18A. Signature 18B. Title 18C. Date

28A. Signature 28B. Title 28C. Date CBP Form 226 (07/07)

I. DECLARATION STATEMENT (Applicable to Item 17 on front of form.)
As master of the said vessel and to the best of my knowledge and belief, I declare that the itemized list on the front of this form is a true statement of the cost of the equipment (including boats) purchased for, or the repair parts or materials to be used, or the expenses of repairs made outside the United States upon the said vessel and that there were no such purchases or expenses outside the United States except as stated. I further declare that I will immediately furnish to the appropriate CBP Officer any information which hereafter comes to my attention which indicates that the costs shown on the itemized list are incorrect or that there are costs which are not itemized. The statement does not include compensation paid to members of the regular crew1 in connection with the installation of any such equipment or making of repairs outside the United States. I have listed below any items that I believe are clearly within the purview of 19 U. S.C. 1466(d)(3), such as dunnage, packing, or temporary devices for the control of cargo. I understand that except as provided in section 4. 14(c), Customs Regulations, the vessel will not be allowed to clear until estimated duties are deposited or a bond on CBP Form 301 is given therefore, and that the vessel is subject to forfeiture if the required report of purchases and expenses is not made. I declare that if no items are listed, then no such equipment or repairs were purchased. If my vessel is of more than 500 gross tons, I declare that no work in the nature of an alteration or rebuilding within the meaning of 46 U.S.C. 12139 and 12151 has been effected in any foreign port or place which as not been separately reported. A copy of any such report is attached. I understand that if a report of such work is not made, the vessel is subject to seizure by and forfeiture to the Government and the owner and I are subject to a penalty of not more than $10,000. Each day of a continuing violation is a separate violation.
1 Crewmembers signed on a vessel solely for the purpose of making repairs are not members of the regular crew within the meaning of 19 U.S.C. 1466(a), and compensation paid to such crewmembers must be reported as foreign labor used in making repairs.

II. ENTRY STATEMENT (Applicable to item 28 on front of form.)
As master of the said vessel or authorized agent of the owner of the vessel and to the best of my knowledge and belief, I declare that (Place "X" in Box "A" or Box "B" in item 28 on the front of the document): A. If I have marked Box "A", this entry contains a full and complete account, together with the cost, at the places and times mentioned, of the equipment (including the boats) purchased for, or the repair parts or materials to be used, or the expenses of the repairs made in a foreign country for the said vessel. B. If I have marked Box "B", this entry contains an incomplete account, together with an estimate of the total cost of the equipment purchased for, or the repair parts or materials to be used, or the expenses of the repairs made in a foreign country, and it is requested that the determination of duty for the entry be suspended pending the furnishing of a complete account of the items liable to duty. I further declare that if at any time hereafter I discover any error in the account now produced or receive any information showing a different state of facts, I will immediately make the same known to the port director of CBP. I hereby stipulate that the estimated duties will be deposited, or bond given therefore, before clearance is granted except on vessels specially exempted by regulations of the Secretary of the Treasury, and that all increased duties that may accrue will be paid when ascertained.

CBP USE ONLY Items within purview of 19 U.S.C. 1466(d)(3) if any: Undeclared Repairs or Purchases

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. These regulations and form require the master of a vessel to make entry on the cost of equipment, or any part thereof purchased, of repair parts or material used or of repairs made in a foreign country. It is mandatory. The estimated average burden associated with collection of information is 30 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be direct to U.S. Customs and Border Protection, Asset Management, Washington, DC 20229 and to the Office of Management and Budget, Paperwork Reduction Project (1651-0027) Washington, DC 20503.

CBP Form 226 (07/07)