DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
COST SUBMISSION
19 U.S.C. 1511
COST SUBMISSION
BY
For the Period
through
CERTIFICATION
Name and Official Company Title
OMB No. 1651-0028
Exp. 03-31-2011
CBP Form 247 (09/02)
This declaration of actual costs, inclusive of attached Exhibits A through D and required supporting
schedules, is complete, accurate, and responsive to the instructions listed hereon to the best of my
knowledge. Any omission resulting in the under payment of duties could result in the assessment of
penalties under the provisions of Section 592, Tariff Act of 1930.
PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask
for the information in order to carry out the laws of U.S. Customs and Border Protection. We need it to ensure importers/
brokers are complying with these laws and to allow us to properly appraise and classify imported merchandise
and to ensure correct values and duties are being reported to CBP. Your response is voluntary. The estimated average
burden associated with this collection of information is 50 hours 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, Information Services Branch, Washington, DC 20229, and to the Office of
Management and Budget, Paperwork Reduction Project (1651-0028), Washington, DC 20503
HOW TO PREPARE THE COST SUBMISSION
EXHIBIT A
1. Materials and Components
Components which are of U.S. manufacturer and which are in condition ready to assemble
without further fabrication are not dutiable. You must maintain auditable records, which
demonstrate that these components were not just purchased in the U.S., but were also
made in the U.S.
Components which are further manufactured prior to assembly are dutiable.
Components of foreign or undetermined origin are dutiable. The value of the components
shall include transportation and relate