Free CBP Form 7551 - Drawback Entry - Federal

DEPARTMENT OF HOMELAND SECURITY

Section I - Claim Header
1. Drawback Entry Number 6. Claimant ID Number 10. Puerto Rico Claimed 16. Method of Filing ABI Manual 2. Entry Type Code 3. Port Code

OMB No. 1651-0075 Expires 10/31/2011
4. Surety Code 5. Bond Type

U.S. Customs and Border Protection DRAWBACK ENTRY
19 CFR 191
PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to carry out U.S. Department of Homeland Security laws and regulations, to determine the eligibility for refund of taxes on domestic alcohol (if applicable), and to determine the proper amount of drawback. Your response is required to obtain or retain a benefit. The estimated average burden associated with this collection of information is 35 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimates and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Asset Management, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0075) Washington, DC 20503.

7. Broker ID Number (CBP 4811) 11. HMF Claimed 12. MPF Claimed

8. DBK Ruling Number 13. Other Taxes/Fees Claimed

9. Duty Claimed 14. Total Drawback Claimed 15. Total I.R. Tax Claimed

17. NAFTA DBK Yes No 20. Name and Address of Claimant Disk

18. Privilege Authorized

19. Drawback Statutory Provision

Accelerated Payment WPN 21. Contact Name, Address, E-mail, Phone & Fax Numbers of Preparer

Section II - Imported Duty Paid, Designated Merchandise or Drawback Product
22. Import Entry Or CM&D Numbers
(List Once in Chronological Order)

23. Port Code

24. Import Date

25. CD

26. (If using 1313(b)) A. B. Date(s) Date(s) Received Used

27. HTSUS No.

28. Description of Merchandise (Include Part/Style/Serial Numbers)

29. Quantity & Unit of Measure

30. Entered Value Per Unit

31. Duty Rate

32. 99% Duty

33. Total 34. STATUS - The Import entries as listed on this form are subject to: (Must be identified on claim or coding sheet) 364 Duty

CBP USE ONLY
Class Code 365 Excise Tax 369 Puerto Rico 398 HMF 399 MPF Other Tax or Fee Total Drawback Claimed INTERNAL CONTROL REVIEW Date Reason 21 23 24 Accelerated Liquidated Bill/Refund

Reconciliation 19 USC 1520 (c)(1)

19 USC 1514, Protest 19 USC 1520 (d)

DATE RECEIVED

DS Number Specialist Code 25 26

IC OK

CBP Form 7551 (07/08)

Section III - Manufactured Articles
35. Quantity & Description of Merchandise Used 36. Date(s) of Manufacture or Production 37. Description of Articles Manufactured or Produced 38. Quantity and Unit of Measure 39. Factory Location

Section IV - Information on Exported or Destroyed Merchandise TO PERIOD COVERED
40. Exhibits to be attached for the following: Relative Value 41. Date
(MM/DD/YYYY)

Petroleum 43. Unique Indentifier No.

Domestic Tax Paid Alcohol 44. Name of Exporter/Destroyer

Piece Goods

Waste Calculation

Recycled

Harbor Maintenance Fee Merchandise Processing Fee Other Taxes/Fees 47. Export Destination 48. HTSUS No.

42. Action Code

45. Description of Articles (Include Part/Style/Serial Numbers)

46. Quantity and Unit of Measure

Section V - Declarations
Same condition to NAFTA countries - The undersigned herein certifies that the merchandise herein described is in the same condition as when it was imported under above import entry(ies) and further certifies that this merchandise was not subjected to any process of manufacturer or other operation except the following allowable operations: The undersigned hereby certifies that the merchandise herein described is unused in the United States and further certifies that this merchandise was not subjected to any process of manufacture or other operation except the following allowable operations: The undersigned hereby certifies that the merchandise herein described is commercially interchangeable with the designated imported merchandise and further certifies that the substituted merchandise is unused in the United States and that the substituted merchandise was in our possession prior to exportation or destruction. Merchandise does not conform to sample or specifications. Merchandise was defective at time of importation. Merchandise was shipped without consent of the consignee.

The undersigned hereby certifies that the merchandise herein described is the same kind and quality as defined in 19 U.S.C. 1313(p)(3)(B), with the designated imported merchandise or the article manufactured or produced under 1313(a) or (b), as appropriate. The article(s) described above were manufactured or produced and disposed of as stated herein in accordance with the drawback ruling on file with CBP and in compliance with applicable laws and regulations. The undersigned acknowledges statutory requirements that all records supporting the information on this document are to be retained by the issuing party for a period of three years from the date of payment of the drawback claim. The undersigned is fully aware of the sanctions provided in 18 U.S.C. 1001 and 18 U.S.C. 550 and 19 U.S.C. 1593a. I declare that according to the best of my knowledge and belief, all of the statements in this document are correct and that the exported article is not to be relanded in the United States or any of its possessions without paying duty.

Member of Firm with Power of Attorney Printed Name and Title

Officer of Corporation Signature and Date

Broker with Power of Attorney

CBP Form 7551 (07/08)