OMB Approved No. 1651-0027 Expires 06/30/2011
19. Entry Number
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
RECORD OF VESSEL
FOREIGN REPAIR OR EQUIPMENT PURCHASE
19 CFR 4.7, 4.14
1. Function of this document (Check one)
(Complete items 1-17 and 20-26)
(Complete items 1-16 and 20-28; 19 if available)
2. Owner Name
3. Represented Locally By: Name
20. Principal Name
4. Vessel Name
5. IMO No.
6. Name of Master
21. Surety Name and Number
7. Last U.S. Departure Port
8. Last U.S. Departure Date
9. Foreign Port Arrived From
10. Voyage No.
11. U.S. Port of Arrival
12. Port Code
13. Arrival Date
23. Bond Amt.
Location (City and Country) and Sailing
Date from that Country
Description of Work Performed Including Identification of
Cost in foreign Money
Duty @ 50% Entered
Cost in U.S. Money
27. TOTAL AMOUNT DECLARED
ITEMS BELOW FOR DECLARATION ONLY, DO NOT USE FOR ENTRY
28. CERTIFICATION OF MASTER OR AUTHORIZED AGENT OF THE OWNER
17. CERTIFICATION OF MASTER
18. CBP USE ONLY
As Master of the said vessel, I hereby subscribe to the
declaration statement on the back of this document.
I have examined the vessel's log, which indicates:
The undeclared repairs or purchases which I have listed on the back of this
No undeclared repairs or purchases.
Vessel not boarded;
Log not examined.
I hereby subscribe to the statement relative to an
entry on the back of this document.
A. Full and Complete
CBP Form 226 (07/07)
I. DECLARATION STATEMENT (Applicable to Item 17 on front of form.)
II. ENTRY STATEMENT (Applicable to item 28 on front of form.)