Free CBP Form 6043 - Delivery Ticket - Federal


File Size: 81.6 kB
Pages: 1
Date: September 11, 2007
File Format: PDF
State: Federal
Category: Government
Word Count: 285 Words, 1,895 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://forms.cbp.gov/pdf/CBP_Form_6043.pdf

Download CBP Form 6043 - Delivery Ticket ( 81.6 kB)


Preview CBP Form 6043 - Delivery Ticket
DEPARTMENT OF HOMELAND SECURITY

Form Approved OMB No. 1651-0081 Exp. 02-28-2010 PORT
ENTRY NUMBER (IT, G.O., Detention, SZ, Other, Describe)

U.S. Customs and Border Protection DELIVERY TICKET
19 CFR 4.34, 4.37, 19.9; 19 USC 1551a, 1565
TRANSFER CARTAGE RELEASE

GOODS DELIVERED TO DATE OF ENTRY

GOODS DELIVERED FROM (Pier, Station, Airport, etc.) DATE OF ARRIVAL

NAME AND ADDRESS OF CONSIGNEE

AIR WAYBILL OR BILL OF LADING NO. NAME OF IMPORTING CARRIER (If Airline, Give Airline and Flt. No.)

LIEN NO.

DATE OF LIEN

LIEN FILED BY

LIEN SATISFIED (19 USC 1564) DATE ENTRY MARKS AND NUMBERS CONT. NUMBER, PIECE COUNT DESCRIPTION OF MERCHANDISE SALE DESTROYED

CONDITION, WEIGHTS, ETC.

TOTAL NO. OF PACKAGES / UNITS SIGNATURE OF CONSIGNEE

Delivered in good condition except as noted QUANTITY DISCREPANCIES NOTE HERE:

Received in good condition except as noted

VEHICLE LICENSE PLATE NUMBER

CUSTODIAL BOND NUMBER OF DELIVERING PARTY (19 CFR 113.63)

C.H. LICENSE NUMBER

TRUCK NUMBER

COMPANY NAME AND SIGNATURE OF CARTMAN/ LIGHTERMAN/ COMMON CARRIER TIME RECEIVING CBP OFFICER DATE TIME

DELIVERING CBP OFFICER

DATE

DELIVERING PROPRIETOR

RECEIVING PROPRIETOR

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 the U.S. Customs and Border Protection. It is mandatory. The estimated average burden associated with this collection of information is 26 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0081), Washington, DC 20503. CBP Form 6043 (07/00)