DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection ENTRY SUMMARY
8. Importing Carrier 12. B/L or AWB No. 16. I.T. No.
1. Filer Code/Entry No.
2. Entry Type
Form Approved OMB No. 1651-0022 EXP. 03-31-2012
3. Summary Date 7. Entry Date
4. Surety No. 5. Bond Type 6. Port Code 10. Country of Origin 14. Exporting Country
9. Mode of Transport 13. Manufacturer ID 17. I.T. Date 22. Consignee No.
11. Import Date 15. Export Date 20. U.S. Port of Unlading 24. Reference No.
18. Missing Docs 19. Foreign Port of Lading 23. Importer No.
21. Location of Goods/G.O. No.
25. Ultimate Consignee Name and Address
26. Importer of Record Name and Address
City 27. Line No.
State
Zip
City 32. A. Entered Value B. CHGS C. Relationship
State 33. A. HTSUS Rate B. ADA/CVD Rate C. IRC Rate D. Visa No.
Zip 34. Duty and I.R. Tax Dollars Cents
28. Description of Merchandise 29. 30. 31. A. HTSUS No. A. Grossweight Net Quantity in B. ADA/CVD No. B. Manifest Qty. HTSUS Units
Other Fee Summary for Block 39
35. Total Entered Value $ Total Other Fees $
A. LIQ CODE
CBP USE ONLY
TOTALS
37. Duty 38. Tax 39. Other 40. Total
B. Ascertained Duty
REASON CODE
C. Ascertained Tax D. Ascertained Other E. Ascertained Total
36. DECLARATION OF IMPORTER OF RECORD (OWNER OR PURCHASER) OR AUTHORIZED AGENT
I declare that I am the Importer of record and that the actual owner, owner purchaser, or consignee for CBP purposes is as shown above, OR or purchaser or agent thereof. I further declare that the merchandise
was obtained pursuant to a purchase or agreement to purchase and that the
prices set forth in the invoices are true, OR was not obtained pursuant to a purchase or agreement to purchase and the statements in the invoices as to value or price are true to the best of my knowledge and belief. I also declare that the statements in the documents herein filed fully disclose to the best of my knowledge and belief the true prices, values, quantities, rebates, drawbacks, fees, commissions, and royalties and are true and correct, and that all goods or services provided to the seller of the merchandise either free or at reduced cost are fully disclosed. I will immediately furnish to the appropriate CBP officer any information showing a different statement of facts.
41. DECLARANT NAME
TITLE
SIGNATURE 43. Broker/Importer File No.
DATE
42. Broker/Filer Information (Name, address, phone number)
Paperwork Reduction Act Notice CBP Form 7501 (06/09)
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET
U.S. Customs and Border Protection
OMB No. 1651-0022 EXP. 03-31-2012
1. Filer Code/Entry No.
27. 29. Line No.
28. Description of Merchandise 30. A. Grossweight B. Manifest Qty. 31. Net Quantity in HTSUS Units A. HTSUS No. B. ADA/CVD No.
32. A. Entered Value B. CHGS C. Relationship
33. A. HTSUS Rate B. ADA/CVD Rate C. IRC Rate D. Visa No.
34. Duty and I.R. Tax Dollars Cents
CBP Form 7501 (06/09)
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET
U.S. Customs and Border Protection
OMB No. 1651-0022 EXP. 03-31-2012
1. Filer Code/Entry No.
27. 29. Line No.
28. Description of Merchandise 30. A. Grossweight B. Manifest Qty. 31. Net Quantity in HTSUS Units A. HTSUS No. B. ADA/CVD No.
32. A. Entered Value B. CHGS C. Relationship
33. A. HTSUS Rate B. ADA/CVD Rate C. IRC Rate D. Visa No.
34. Duty and I.R. Tax Dollars Cents
CBP Form 7501 (06/09)
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET
U.S. Customs and Border Protection
OMB No. 1651-0022 EXP. 03-31-2012
1. Filer Code/Entry No.
27. 29. Line No.
28. Description of Merchandise 30. A. Grossweight B. Manifest Qty. 31. Net Quantity in HTSUS Units A. HTSUS No. B. ADA/CVD No.
32. A. Entered Value B. CHGS C. Relationship
33. A. HTSUS Rate B. ADA/CVD Rate C. IRC Rate D. Visa No.
34. Duty and I.R. Tax Dollars Cents
CBP Form 7501 (06/09)
DEPARTMENT OF HOMELAND SECURITY ENTRY SUMMARY CONTINUATION SHEET
U.S. Customs and Border Protection
OMB No. 1651-0022 EXP. 03-31-2012
1. Filer Code/Entry No.
27. 29. Line No.
28. Description of Merchandise 30. A. Grossweight B. Manifest Qty. 31. Net Quantity in HTSUS Units A. HTSUS No. B. ADA/CVD No.
32. A. Entered Value B. CHGS C. Relationship
33. A. HTSUS Rate B. ADA/CVD Rate C. IRC Rate D. Visa No.
34. Duty and I.R. Tax Dollars Cents
CBP Form 7501 (06/09)