Customs Declaration19 CFR 1 22.27, 148.12, 148.13, 148.110,148.111, 14S8i 31 CFR 531 6

FORMAPPROVEDOil,lB NO. 1651-0009

Each arriving traveler or responsible family member must provide the followinginformation (only ONE wriften declaration per family is required):

1. FamilyName

Ftlr.;t (Giorn) Middle

2. Birdr date D^y Month Year

3. Number of Family members traveling with you

4. (a) U.S. Street Address (hotel name/destination)

(b) City (c) State

5. Passport issued by (country)

6. Passport number

7. Country of Residence

8. Countries visited on this

rip prior to U.S. arrival

9. Airline/Flight No. or Vessel Name

10. The primary purpose of this trip is business: Yes No

I l. I am (We are) bringing(a) fruits, vegetables, plants, seeds, food, insects: Yes No

(b) meats, animals, animaVwildlife products: Yes No

(c) disease agents, cell cultures, snails: Yes No

(d) soil or have been on a fann/rancVpasture: Yes No12.I have QV'e have) been in close proximity of

(such as touching or handling) livestock: Yes No

I 3. I am (We are) carrying currency or monetaryinstruments over $10,000 U.S. or foreign equivalent Yes No(see definition of monetary instrurnents on reverse)

14.I have (We have) commercial merchandise: Yes No(articles for sale, samples used for soliciting orders,or goods that are not considered perconal effects)

l5.Residents - the total value of all goods, including commercialmerchandise I/we have purchased or acquired abroad, (including giftsfor someone else, but not items mailed to the U.S.) and amlare bringingto the U.S. is: $Visitors - the total value of all articles that will remain in the U.S..including commercial merchandise is: $

Read the instructions on the back of this form. Soace is nrovided to list all theitems you must declare.I HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OFTHI$ FORM AND HAVE MADE A TRUTHFUL DECLARATION.

CBP Form 60598 (01/04)

For Official Use Onll'

U.S. Customs and Border ProtectionWelcomes You to the United States

U.S. Customs and Border Protection is responsible for protecdng the UnitedStates against the illegal importation of prohibited items. CBP officers have theauthority to question you and to examine you and your personal properry. Ifyou are one ofthe travelers selected for an examinarion, you will be treated in acourteous, professional, and dignified manner. CBP Supervisors and PassengerService Representatives are available to answer your questions. Comment cardsare available to compliment or provide feedback.

lmpoitant InformationU.S. Residents - declare all articles tiat you have acquired abroad and arebringing into the United States.

Visitors (Non-Residents) - declare the value of all articles that will remainin the United States.

Declare all articles on this declaration form and show the value in U.S. dollars.For gifis, please indicate the retail value.

D.tty - CBP officers will determine duty. U.S. residents are normally entitledto a duty-free exemption of $800 on items accompanying them. Visitors (non-residents) are normally entided to an exemption of $100. Dury witl be assessedat the current rate on the first $1,000 above the exemption.Controlled substances, obscene articles, and toxic substances aregenerally prohibited entfy. Agriculture products are reefficted entry.

Thank You, anil Vlhlccme to tbe IJniteil Statet.

The transportation of currency or monetary instruments, regardless of theamount, is legal. However, if you bring in to or take out of tle United Statesmore than $10,000 (U.S. or foreign equivalent, or a combination of both), you arerequired by law to file a report on FinCEN 105 (formerly Customs Form 4790)with U.S. Customs and Border Protection. Monetary instruments include coin.currency, travelers check and bearer instruments such as personal or cashiers checksand stocks and bonds. If you have someone else carry the currency or monetaryinstrument for vou. vou must also file a reDort on FinCEN 105. Faiiure to file th!requ.ired report or ir'il*" to report the tut;l amotrrft that you.are carrying may leadto ttre seizure of all the currency or monetary instruments, and may subject you tocivil penalties and/or criminal prosecution. SIGN ON THE OPPOSffE SIDE OFTHIS FORA4 AFTER YOU TIA\,'E READ THE IIVTPORTI{NT INFOR.N,IAIIONABOVE AND MADE A TRUTHFI]L DECLAMTION.Description of Articles(List may contlnue on another CBP Form 60598) ValUe

Total

PAPERWORK REDUCTION ACf NOTICE: Th6 Paperuod( Reduclion Acl says w must tell you why we are mllecting thls intomation,t|o\ir lve will use it, and wheths you have to giv€ il to us. The information collecied on this fom is needed to c€rry out the Customs,Agticulhire, ad urency laws of the Unihd Stales. CBP requires the infornation on lfiis form to in6ure that travelers are mmplyingwih t€s hs and io allow us to figure and mllect lhe fight amount of duty and tax. Your response is mandatory- An agencl may not$rduct s sponw, and a poFon is rct requiFd to 6pond to a coll€clion of infomation, unless it displays a valid oMB 6ntml numberThe estimaH avemge burdon a$miated with lhis mllecton of infomation is 4 minutes per respondent or recod keeper depending onindividul cirdmstances. Comm€nts conceming the amumcy of $is burden estimate and suggesllons for rcducing this burden shouldbe directed to U.S. Custons and Bordsr Prdtection, Repons Clearanm offmr, lnfomation Seryices Branch, Washing'ton, Dc20229, and to the Offce ofManagemont and Budget, PapeMo* Reducdon Project (1651.0009), Washington, DC 20503. THIS FORMI{AY NOT gE REPRODUCED WTHOUT APPROVAT FROI,I THE CBP FORMS MAI'IAGER'u.S. G.Po.:2005 - 783-076/80026 CBP Form 60598 (01/04)

CBPtlse Only