Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond
to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is
1651-0024. The estimated average time to complete this application is 15 minutes. If you have any comments regarding the burden estimate
you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.
ENTRY/IMMEDIATE DELIVERY
27. CERTIFICATION
28. CBP USE ONLY
X
CBP Form 3461 (10/09)
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
Form Approved
OMB No. 1651-0024
Exp. 01-31-2012
19 CFR 142.3, 142.16, 142.22, 142.24
1. ARRIVAL DATE
5. PORT
2. ELECTED ENTRY DATE 3. ENTRY TYPE CODE/NAME
4. ENTRY NUMBER
6. SINGLE TRANS. BOND 7. BROKER/IMPORTER FILE NUMBER
8. CONSIGNEE NUMBER
9. IMPORTER NUMBER
10. ULTIMATE CONSIGNEE NAME
11. IMPORTER OF RECORD NAME
12. CARRIER CODE
13. VOYAGE/FLIGHT/TRIP 14. LOCATION OF GOODS-CODE(S)/NAME(S)
15. VESSEL CODE/NAME
16. U.S. PORT OF UNLADING
17. MANIFEST NUMBER
18. G.O. NUMBER
19. TOTAL VALUE
20. DESCRIPTION OF MERCHANDISE
21. IT/BL/AWB
CODE
22. IT/BL/AWB NO.
23. MANIFEST QUANTITY
24. H.S. NUMBER
25. COUNTRY
OF ORIGIN
26. MANUFACTURER NO.
I hereby make application for entry/immediate delivery. I certify that the above
information is accurate, the bond is sufficient, valid, and current, and that all
requirements of 19 CFR Part 142 have been met.
SIGNATURE OF APPLICANT
PHONE NO.
DATE
29. BROKER OR OTHER GOVT. AGENCY USE
OTHER AGENCY ACTION REQUIRED, NAMELY:
CBP EXAMINATION REQUIRED.
ENTRY REJECTED, BECAUSE:
DELIVERY
AUTHORIZED:
SIGNATURE
DATE