DEPARTMENT OF HOMELAND SECURITY
Form Approved OMB No. 1651-0081 Exp. 02-28-2010 PORT
ENTRY NUMBER (IT, G.O., Detention, SZ, Other, Describe)
U.S. Customs and Border Protection DELIVERY TICKET
19 CFR 4.34, 4.37, 19.9; 19 USC 1551a, 1565
TRANSFER CARTAGE RELEASE
GOODS DELIVERED TO DATE OF ENTRY
GOODS DELIVERED FROM (Pier, Station, Airport, etc.) DATE OF ARRIVAL
NAME AND ADDRESS OF CONSIGNEE
AIR WAYBILL OR BILL OF LADING NO. NAME OF IMPORTING CARRIER (If Airline, Give Airline and Flt. No.)
LIEN NO.
DATE OF LIEN
LIEN FILED BY
LIEN SATISFIED (19 USC 1564) DATE ENTRY MARKS AND NUMBERS CONT. NUMBER, PIECE COUNT DESCRIPTION OF MERCHANDISE SALE DESTROYED
CONDITION, WEIGHTS, ETC.
TOTAL NO. OF PACKAGES / UNITS SIGNATURE OF CONSIGNEE
Delivered in good condition except as noted QUANTITY DISCREPANCIES NOTE HERE:
Received in good condition except as noted
VEHICLE LICENSE PLATE NUMBER
CUSTODIAL BOND NUMBER OF DELIVERING PARTY (19 CFR 113.63)
C.H. LICENSE NUMBER
TRUCK NUMBER
COMPANY NAME AND SIGNATURE OF CARTMAN/ LIGHTERMAN/ COMMON CARRIER TIME RECEIVING CBP OFFICER DATE TIME
DELIVERING CBP OFFICER
DATE
DELIVERING PROPRIETOR
RECEIVING PROPRIETOR
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 and regulations administered by the U.S. Customs and Border Protection. It is mandatory. The estimated average burden associated with this collection of information is 26 minutes 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 (1651-0081), Washington, DC 20503. CBP Form 6043 (07/00)