CBP Form 7552 Instructions

OMB 1651-0075 Exp. 08/31/2008

DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection DELIVERY CERTIFICATE FOR PURPOSES OF DRAWBACK 19 CFR 191 PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to carry out U.S. Department of Homeland Security laws and regulations, to determine the eligibility for refund of taxes on domestic alcohol (if applicable), and to determine the proper amount of drawback. Your response is required to obtain or retain a benefit. The estimated average burden associated with this collection of information is 33 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 Division, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0075) Washington, DC 20503

Certificate of Delivery

Certificate of Manufacture and Delivery

1. CM&D No.

2. Port Code

3.DBK Ruling No.

4. Type Code

5. ID No. of Transferor

6. FROM TRANSFEROR: Company Name and Complete Address

7. TO TRANSFEREE: Company Name and Complete Address

R ECEIVED DATE

IMPORTED DUTY PAID, DESIGNATED MERCHANDISE OR DRAWBACK PRODUCT

8. Use

9. Import Entry or CM&D Number

10. Port Code

11. Import Date (MMDDYYYY)

12. CD

13. (If using 1313(b)) A. B. Date(s) Date(s) Received Used

14. Date Delivered

15. HTSUS No.

16. Description of Merchandise (Include Part /Style/Serial Numbers)

17. Quantity & Unit of Measure

18. Entered Value Per Unit

19. 100% Duty

21. Contact Name and Address

PREPARER Phone Number ( ) _______ - _________ Ext.________ FAX Number ( ) _______ - _________

20. Total

CBP Form 7552 (07/08)

22.

Quantity & Description

of Merchandise Used

23.

Date(s) of Manufacture

(MMDDYYYY)

24.

Description of Articles Manufactured or Produced

(Include Part /Style/Serial Numbers)

25.

Quantity &

Unit of

Measure

26.

Date Delivered

27.

Duty Available on Manufacture Articles

(Total of Duties in Block 20)

28.

Drawback Available Per Unit of Measure

on Manufactured Article

29.

Factory Location

30. Exhibits to be attached for the following:

Relative

Value

Petroleum

Domestic Tax

Paid Alcohol

Piece Goods

Waste

Calculation

Recycled

Harbor Maintenance Fee

Merchandise Processing Fee

Other Taxes/Fees

31. STATUS - Import Entries listed on this form are subject to (If CD, identify on this form; if CM&D, identify on coding sheet):

Reconciliation 19 USC 1514, Protest 19 USC 1520 (c)(1) 19 USC 1520 (d)

The undersigned acknowledges statutory requirements that all records supporting the information on this document are to be retained by the issuing party for a period of three years from the date of payment of the related drawback entry. Assignment of Rights is transferred when this form is prepared as a CD or CM&D. I declare that according to the best of my knowledge and belief, all of the statements in this document are correct and I am fully aware of the sanctions provided in 18 U.S.C. 1001 and 18 U.S.C. 550 and 19 U.S.C. 1593a.

Printed Name and Title

Signature and Date

DECLARATIONS

The merchandise transferred on this CD is the imported merchandise.

The merchandise transferred on this CD is pursuant to 19 U.S.C. 1313(j)(2) and will not be designated for any other Drawback purposes.

The article(s) described above were manufactured or produced and delivered as stated herein in accordance with the Drawback ruling on file with CBP and in compliance

with applicable laws and regulations.

This Certificate of Delivery is a subsequent transfer and the merchandise is the same as received.

Member of Firm with Power of Attorney Officer of Corporation Broker with Power of Attorney

CBP Form 7552 (07/08)