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APPENDIX C CUSTOMS DECLARATION.
WELCOME to the UNITED STATES
DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE
CUSTOMS DECLARATION
____________________________________________________________
Each arriving traveler or head of family must provide the following
information (only ONE written declaration per family is required):
1. Name: ____________________________________________________
Last First Middle Initial
2. Date of birth: _______/______/_____ 3. Airline/Flight ______________
4. Number of family members traveling with you ____________________
5. U. S. Address: ______________________________________________
City: ______________________________ State: __________________
6. I am a U. S. Citizen
If No, YES NO
Country: ___________________.
7. I reside permanently in the U. S.
If No, YES NO
Expected Length of Stay _______.
8. The purpose of my trip is or was
BUSINESS PLEASURE
9. I am/we are bringing fruits, plants, meats, food YES NO
soil, birds, snails, other live animals, farm
products, or I/we have been on a farm or ranch
outside the U. S.
10. I am/we are carring currency or monetary YES NO
instruments over $10,000 U. S. Or
foreign equivalent.
11. The total value of all goods I/we purchased or
acquired abroad and am/are bringing to the U. S.
Is (see instruction under Merchandise on reverse
side): $____________.
Us Dollars
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