Transcription of U.S. Department of State Expires: 03-31-2018 REQUEST FOR ...
1 Department of State orIf Newly Assigned Check CUSTOMS COPYE nter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs.
2 Or Entry NumberDescription of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and of Authorized Representative of International Organization (Includes )Date (mm-dd-yyyy)Embassy or Consulate Sealand Department of Customs AuthorizationOMB Approval No. 1405-0105 Expires: 03-31-2018 Estimated burden: 15 MinutesSee Page 7 Date (mm-dd-yyyy)Free Entry RequestedName (First, Middle, Last)Page 1 of 7DS-1504 Department of State orIf Newly Assigned Check HereEnter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below.
3 This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs. or Entry NumberDescription of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and of Authorized Representative of International Organization (Includes )Date (mm-dd-yyyy)Embassy or Consulate Sealand Department of Customs AuthorizationOMB Approval No.
4 1405-0105 Expires: 03-31-2018 Estimated burden: 15 MinutesSee Page 7 Date (mm-dd-yyyy)Free Entry RequestedName (First, Middle, Last)APPROVED COPYDS-1504 Page 2 of Department of State orIf Newly Assigned Check HereEnter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs.
5 Or Entry NumberDescription of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and of Authorized Representative of International Organization (Includes )Date (mm-dd-yyyy)Embassy or Consulate Sealand Department of Customs AuthorizationOMB Approval No. 1405-0105 Expires: 03-31-2018 Estimated burden: 15 MinutesSee Page 7 Date (mm-dd-yyyy)Free Entry RequestedName (First, Middle, Last) CUSTOMS COPYDS-1504 Page 3 of Department of State orIf Newly Assigned Check HereEnter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below.
6 This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs. or Entry NumberDescription of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and of Authorized Representative of International Organization (Includes )Date (mm-dd-yyyy)Embassy or Consulate Sealand Department of Customs AuthorizationOMB Approval No.
7 1405-0105 Expires: 03-31-2018 Estimated burden: 15 MinutesSee Page 7 Date (mm-dd-yyyy)Free Entry RequestedName (First, Middle, Last) CUSTOMS COPYDS-1504 Page 4 of Department of State orIf Newly Assigned Check HereEnter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs.
8 Or Entry NumberDescription of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and of Authorized Representative of International Organization (Includes )Date (mm-dd-yyyy)Embassy or Consulate Sealand Department of Customs AuthorizationOMB Approval No. 1405-0105 Expires: 03-31-2018 Estimated burden: 15 MinutesSee Page 7 Date (mm-dd-yyyy)Free Entry RequestedName (First, Middle, Last)OFM COPYDS-1504 Page 5 of Department of State orIf Newly Assigned Check HereEnter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below.
9 This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs. or Entry NumberDescription of Merchandise - Including warehouse or Catalogue Number (if withdrawn from a customs bonded warehouse or foreign trade zone). If vehicle, include Vehicle Identification Number, Make, Model, and of Authorized Representative of International Organization (Includes )Date (mm-dd-yyyy)Embassy or Consulate Sealand Department of Customs AuthorizationOMB Approval No.
10 1405-0105 Expires: 03-31-2018 Estimated burden: 15 MinutesSee Page 7 Date (mm-dd-yyyy)Free Entry RequestedName (First, Middle, Last)CUSTOMER COPYDS-1504 Page 6 of Department of State orIf Newly Assigned Check HereEnter PIDREQUEST FOR CUSTOMS CLEARANCE OF MERCHANDISEName of Embassy, Legation, or International Organization (Includes )To the Secretary of State - Attention: Office of Foreign MissionsIt is requested that the necessary arrangements be made for the appropriate authorities to admit free of duty the merchandise described below. This merchandise is intended for the personal and/or official use of the person(s) or foreign government noted based on reciprocity or, for representatives ofinternational organizations, or others herein designated, based on privileges under the authority specified on the of ClearanceConsigneeTitlePurposeOfficial (Explain Below)PersonalOfficial and PersonalCarrier/SupplierCustoms Entry or Manifest NumberAir Waybill or Bill of Lading NumberTotal Weight lbs.
