rm
s Declaration Fo
The U.S. Custom
This Space For Official Use Only
U.S. Cu
Customs Declaration
FORM APPROVED OMB NO.1651-0009
19 CFR 122.27, 148.12, 148.13, 148.110, 148.111, 1498; 31 CFR 5316
What is this and why do I need to fill this out? Before you arrive in the U.S., you will need to fill out the US Customs Declaration Form. If you‘re traveling with your family only the head of the family needs to fill out the form. When you arrive on US soil you will hand this form to the U.S. Customs agent. If you’re traveling with fruits we recommend disposing of them before or during your flight to the U.S. but what happens if you answer yes to any of the questions? It’s not as terrible as you might think and being truthful will save you a lot of trouble and a fine of up to $300. See page 90 for more information on answering YES.
Each arriving traveler or responsible family member must provide the following information (only ONE written declaration per family is required). The term "family" is defined as "members of a family residing in the same household who are related by blood, marriage, domestic relationship, or adoption." 1 Family Name First (Given) 2 Birth date
MAGNUSSON HAKON Month 0 2
VALUR Year 8 0 2
Middle Day
1 7
3 Number of Family members traveling with you 4 (a) U.S. Street Address (hotel name/destination)
BOSTON HARBOR HOTEL 70 ROWES WHARF (c) State MA BOSTON Passport issued by (country) ICELAND Passport number A0182382 Country of Residence ICELAND FRANCE ~ SPAIN Countries visited on this (b) City
5 6 7 8
trip prior to U.S. arrival
9 Airline/Flight No. or Vessel Name
Français Le formulaire de déclaration en douane américaine
Qu’est-ce que c’est et pourquoi dois-je en remplir un ? FR: Avant votre arrivée aux États-Unis, vous devrez remplir le formulaire de déclaration en douane américaine. Si vous voyagez avec votre famille, seul le chef de famille doit le remplir. Lorsque vous arrivez sur le sol américain, vous donnez ce formulaire aux autorités douanières américaines. Si vous voyagez avec des fruits, nous vous recommandons de les jeter avant ou pendant votre vol vers les États-Unis mais que se passe-t-il si vous répondez « oui » à l’une de ces questions ? Ce n’est pas aussi terrible que ça en a l’air et dire la vérité vous évitera pas mal d’ennuis et une amende pouvant aller jusqu’à 300 $. Consultez la page 90 pour obtenir plus d’informations si vous répondez « OUI ».
88
WOW Power to the people
WW-125
10 The primary purpose of this trip is business:
Pour remplir ce formulaire, utilisez uniquement des majuscules. Si vous faites une erreur, notre personnel vous donnera un nouveau formulaire. Chaque voyageur entrant ou chef de famille entrant doit fournir les informations suivantes (UNE SEULE déclaration par famille) 1. Nom, Prénom, Initiale du deuxième prénom.
No
(a) fruits, vegetables, plants, seeds, food, insects:
Yes
No
(b) meats, animals, animal/wildlife products:
Yes
No
(c) disease agents, cell cultures, snails:
Yes
No
(d) soil or have been on a farm/ranch/pasture:
Yes
No
12 I have (We have) been in close proximity of livestock: Yes
No
x x x x x
Yes
No
x
Yes
No
x
(such as touching or handling) 13 I am (We are) carrying currency or monetary instruments over $10,000 U.S. or foreign equivalent: (see definition of monetary instruments on reverse) 14 I have (We have) commercial merchandise:
4.
(a) Adresse Aux États-Unis (Destination ou nom de l‘hôtel) (b) Ville (c) Etat
5. Lieu de délivrace du passeport (nom du pays) 6. Numéro de passeport 7. Pays de résidence
The tra the amo States of both) Custom Moneta bearer bonds. instrum file the carrying instrum prosecu YOU H MADE A
Descrip
(List may
(articles for sale, samples used for soliciting orders,
2. Date de naissance Jour/Mois/Année. 3. Nombre de personnes voyageant avec vous.
x
Yes
11 I am (We are) bringing
U.S. Cu United officers persona examin dignified Repres are ava Importa U.S. Re are Visitors rem Declare do Duty— en the of ab Agricul ag Fr bir de Cu W su Contro genera
or goods that are not considered personal effects)
15 RESIDENTS—the total value of all goods, including commercial merchandise I/we have purchased or acquired abroad, (including gifts for someone else but not items mailed to $ the U.S.) and am/are bringing to the U.S. is: VISITORS—the total value of all articles that will remain in the U.S., including commercial merchandise is:
$
0 0
Read the instructions on the back of this form. Space is provided to list all the items you must declare. I HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION.
X
Hákon Valur Magnússon
Signature
01/26/2016
Date (month/day/year)
CBP Form 6059B (04/14)
PAPERW sponsor informati number this app commen Border P Washing