ITA-361P Request for Refund of Duties on Articles Entered Duty Pa

OMB No. 0625-0134
Expires 3/31/09

U. S. DEPARTMENT OF COMMERCE

U. S. DEPARTMENT OF THE INTERIOR

REQUEST FOR REFUND OF DUTIES
ON ARTICLES ENTERED DUTY PAID
(P.L. 97-446, AS AMENDED BY P.L. 103-465, P.L. 106-36 AND P.L. 108-429)

FORM ITA-361P
REV. 3-06

This form must be completed in order to obtain duty refunds pursuant to P.L. 97-446, AS AMENDED BY P.L. 103-465, P.L. 106-36 AND P.L. 108-429

A. This request for refund is made pursuant to Certicate of Entitlement (Form ITA-360P) Number
issued to
, on
, and expiring
B. The number of this request is

and is in the amount of $

C. Duties are requested to be refunded to:

.

City, State, ZIP Code

Check whether affiliated

or not affiliated

D. Certification by Department of Commerce:

.
.

Name

,
.

Address

,

Signature of Authorized Company Official

with the certificate holder.
,

Date

,

Typed name and title

FTS Number

Signature

INSTRUCTIONS FOR CERTIFICATE HOLDER:
Complete blocks A, B, and C. Enter the related information requested on the reverse
side of your certificate (Form ITA-360P), sign in block C above, and submit to:
Statutory Imports Program Staff
International Trade Administration
U.S. Department of Commerce
Washington, D.C. 20230

Public reporting for this collection of information is established to average 10 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the date needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden to Reports Clearance Officer, Internatinal Trade Administration, U.S. Dept. of
Commerce, Room 4001, 14th & Constitution Ave. NW, Washington, D.C. 20230.

Your copy (Copy E) will be returned to you after certification by the Department of Commerce.
INSTRUCTIONS FOR CUSTOMS OFFICIAL:
Provided that this form is presented to you on or before the expiration date shown in block A and the
certifications in block D above and block E (1) of Copy B have been executed, you are authorized to refund
the duties on articles that entered the United States duty paid with the exception of articles containing any
material which is the product of a country with respect to which Column 2 rates of duty apply, which were
made within the three-year period beginning two years prior to the date of issuance of the Certificate of
Entitlement described in block A. This request for refund of duties must be presented to you by the party
shown in block C, together with any other documentation required by applicable regulations of the U.S.
Customs and Border Protection. You may verify the validity of this request by telephoning the Commerce
official shown in block D. You may verify the information supplied by the claimant in block E (1) from your
records. After the U.S. Customs and Border Protection has refunded the requested duties, enter the pertinent
information in block E (2) of Copy B, ensuring that the information is legible on the remaining copies. This
form may be used as often as necessary to exhaust the amount shown in block B. When the total amount of
gross duties refunded equals the amount shown in block B, return the original and Copy C to Commerce at
the address shown above. The form should also be returned to Commerce in the event it is presented after
the expiration date shown in block A, and in that event no refund of duties is permitted. If additional
instructions are needed, telephone the Commerce official shown in block D. THE ORIGINAL AND
COPIES B, C, AND D SHOULD REMAIN AFFIXED TOGETHER UNTIL EXPIRATION OR THE
AMOUNT IN BLOCK B IS EXHAUSTED, WHICHEVER OCCURS FIRST.
ORIGINAL

THIS DOCUMENT MUST BE PRESENTED TO THE U.S. CUSTOMS AND BORDER PROTECTION OFFICER AT THE
PORT OF ENTRY WHERE THE ARTICLES FOR WHICH REFUND OF DUTIES IS REQUESTED WERE ENTERED

OMB No. 0625-0134
Expires 3/31/09

U. S. DEPARTMENT OF COMMERCE
FORM ITA-361P
REV. 3-06

U. S. DEPARTMENT OF THE INTERIOR

REQUEST FOR REFUND OF DUTIES
ON ARTICLES ENTERED DUTY PAID
(P.L. 97-446, AS AMENDED BY P.L. 103-465, P.L. 106-36 AND P.L. 108-429)

A. This request for refund is made pursuant to Certificate of Entitlement (Form ITA-360P) Number
issued to
, on
, and expiring
B. The number of this request is

and is in the amount of $

C. Duties are requested to be refunded to:

.
.

Check whether affiliated

.

Name

City, State, ZIP Code

or not affiliated

D. Certification by Department of Commerce:

,

Address

Signature of Authorized Company Official

with the certificate holder.
,

Date

,

Typed name and title

,
.

FTS Number

Signature

E. Refund Information:
(1) Refunds requested: (to be completed by claimant)
FY

Entry number

Port

Entry date

Duties

Claimant’s
initials/date
(each claim)

(2) Refunds paid: (to be completed by Customs)
Gross duties refunded:
Less Customs reimbursement:
Net duties refunded:
/
Customs initials date

Subtotal:
Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

DECLARATION BY CLAIMANT: I declare that the information given above is true and
correct to the best of my knowledge and belief; that no notices of exportation of articles
with benefit of drawback were filed upon exportation of this merchandise from the
United States; that no liquidated refunds on the articles relating to the present claim have
been paid; and that no protest or request for litigation for refund of duties paid and
herewith claimed has been made.

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
/
Customs initials date

Customs signature (when last refund is made)

COPY B

NOTICE TO CUSTOMS: Do not accept this document unless it is accompanied by the
original (see instructions thereon). After completing block E (2), retain this copy for your
records. Copy C is the Department of Commerce copy. Copy D is the broker’s copy.

Subtotal:
TOTAL:

OMB No. 0625-0134
Expires 3/31/09

U. S. DEPARTMENT OF COMMERCE
FORM ITA-361P
REV. 3-06

U. S. DEPARTMENT OF THE INTERIOR

REQUEST FOR REFUND OF DUTIES
ON ARTICLES ENTERED DUTY PAID
(P.L. 97-446, AS AMENDED BY P.L. 103-465, P.L. 106-36 AND P.L. 108-429)

A. This request for refund is made pursuant to Certificate of Entitlement (Form ITA-360P) Number
issued to
, on
, and expiring
B. The number of this request is

and is in the amount of $

C. Duties are requested to be refunded to:

.
.

Check whether affiliated

.

Name

City, State, ZIP Code

or not affiliated

D. Certification by Department of Commerce:

,

Address

Signature of Authorized Company Official

with the certificate holder.
,

Date

,

Typed name and title

,
.

FTS Number

Signature

E. Refund Information:
(1) Refunds requested: (to be completed by claimant)
FY

Entry number

Port

Entry date

Duties

Claimant’s
initials/date
(each claim)

(2) Refunds paid: (to be completed by Customs)
Gross duties refunded:
Less Customs reimbursement:
Net duties refunded:
/
Customs initials date

Subtotal:
Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

DECLARATION BY CLAIMANT: I declare that the information given above is true and
correct to the best of my knowledge and belief; that no notices of exportation of articles
with benefit of drawback were filed upon exportation of this merchandise from the
United States; that no liquidated refunds on the articles relating to the present claim have
been paid; and that no protest or request for litigation for refund of duties paid and
herewith claimed has been made.

Claimant’s signature (when first claim is made)

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
/
Customs initials date

Customs signature (when last refund is made)

COPY C

DEPARTMENT OF COMMERCE COPY

Subtotal:
TOTAL:

OMB No. 0625-0134
Expires 3/31/09

U. S. DEPARTMENT OF COMMERCE
FORM ITA-361P
REV. 3-06

U. S. DEPARTMENT OF THE INTERIOR

REQUEST FOR REFUND OF DUTIES
ON ARTICLES ENTERED DUTY PAID
(P.L. 97-446, AS AMENDED BY P.L. 103-465, P.L. 106-36 AND P.L. 108-429)

A. This request for refund is made pursuant to Certificate of Entitlement (Form ITA-360P) Number
issued to
, on
, and expiring
B. The number of this request is

and is in the amount of $

C. Duties are requested to be refunded to:

.
.

Check whether affiliated

.

Name

City, State, ZIP Code

or not affiliated

D. Certification by Department of Commerce:

,
.

,

Address

Signature of Authorized Company Official

with the certificate holder.
,

Date

,

Typed name and title

FTS Number

Signature

E. Refund Information:
(1) Refunds requested: (to be completed by claimant)
FY

Entry number

Port

Entry date

Duties

Claimant’s
initials/date
(each claim)

(2) Refunds paid: (to be completed by Customs)
Gross duties refunded:
Less Customs reimbursement:
Net duties refunded:
/
Customs initials date

Subtotal:
Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
Subtotal:

/
Customs initials date

DECLARATION BY CLAIMANT: I declare that the information given above is true and
correct to the best of my knowledge and belief; that no notices of exportation of articles
with benefit of drawback were filed upon exportation of this merchandise from the
United States; that no liquidated refunds on the articles relating to the present claim have
been paid; and that no protest or request for litigation for refund of duties paid and
herewith claimed has been made.

Claimant’s signature (when first claim is made)

Gross duties refunded:

Less Customs reimbursement:
Net duties refunded:
/
Customs initials date

Customs signature (when last refund is made)

COPY D

BROKER’S COPY

Subtotal:
TOTAL:

OMB No. 0625-0134
Expires 3/31/09

U. S. DEPARTMENT OF COMMERCE
FORM ITA-361P
REV. 3-06

U. S. DEPARTMENT OF THE INTERIOR

REQUEST FOR REFUND OF DUTIES
ON ARTICLES ENTERED DUTY PAID
(P.L. 97-446, AS AMENDED BY P.L. 103-465, P.L. 106-36 AND P.L. 108-429)

A. This request for refund is made pursuant to Certificate of Entitlement (Form ITA-360P) Number
issued to
, on
, and expiring
B. The number of this request is

and is in the amount of $

C. Duties are requested to be refunded to:

.

City, State, ZIP Code

Check whether affiliated

or not affiliated

D. Certification by Department of Commerce:
Typed name and title

.
.

Name

Address

Signature of Authorized Company Official

with the certificate holder.
,

Date

,

,
.

FTS Number

Signature

COPY E

NOTICE TO CERTIFICATE HOLDER: Do not remove this copy. The Department of
Commerce will return it for your records after your request is certified.

,