Free CBP Form 7553 - Notice of Intent to Export, Destroy or Return Merchandise for Purposes of Drawback - Federal

OMB No. 1651-0075 Exp. 10/31/2011

DEPARTMENT OF HOMELAND SECURITY

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We
ask for the information in order to enforce the laws of the United States, to fulfill the U.S. Customs Regulations, to ensure that the claimant is entitled to drawback, and to have the necessary information which permits CBP to calculate and refund (or increase) the correct amount of duty and/or tax. Your response is required to obtain a benefit. The estimated average burden associated with this collection of information is 33 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, Asset Management, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0075) Washington, DC 20503.

U.S. Customs and Border Protection
NOTICE OF INTENT TO EXPORT, DESTROY OR RETURN MERCHANDISE FOR PURPOSES OF DRAWBACK
19 CFR 191

1. Exporter or Destroyer Name Address

2. Drawback Entry No.

3. Intended Action Export Destroy

4. Intended Date of Action (MM/DD/YYYY)

5. Drawback Center

6. Contact Name Address

DATE RECEIVED

I.D. Number

Phone FAX

Ext.

7. Location of Merchandise

8. Method of Destruction

9. Location of Destruction

10. Exporting Carrier Name (if known)

11. Intended Port of Export 13. T & E No.

12. Unique Identifier No. 14. Country of Ultimate Destination 18. Quantity & Unit of Measure 19. HTSUS No./Schedule B

15. Import Entry No.

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

17. Drawback Amount

20. Drawback to be filled as: Unused Merchandise Drawback J1 J2 Manufacturing Drawback 21. Preparer Same Condition Drawback under NAFTA Distilled Spirits, Wine or Beer under 26 U.S.C. 5062 (c)

Rejected Merchandise Shipped without Consent Defective at Time of Importation Not Conforming to Sample or Specifications THIS FORM MUST BE SUBMITTED WITH THE DRAWBACK CLAIM

X
Printed Name Signature Title Date

CBP USE ONLY
22. Examination Required or Waived 25. Printed Name Phone Number 26. Signature & Badge No. 30. Date Destroyed or Exam Conducted 31. Printed Name of Examining Officer 32. Signature & Badge No.
(Additional information may be required if exam requested, T & E may be required)

29. Comments/Results of Examination or Witnessing of Destruction. (Merchandise matches invoice description)

23. Present Merchandise to CBP at:

X
24. Destruction to be Witnessed by Yes No Customs 27. Date 28. Port Phone Number Ext

X
Date

CBP Form 7553 (07/08)