I, __________, declare that the articles herein specified are the articles which, in the condition in which they were exported from the United States, were received by me (us) on ____________, 19 ______, from ________________ (name and address of owner or exporter in the United States); that they were received by me (us) for the sole purpose of being processed; that only the processing described below was effected by me (us); that the full cost or (when no charge is made) value of such processing and the value of the articles after processing are correctly stated below; and that no substitution whatever has been made to replace any of the articles originally received by me (us) from the owner or exporter thereof mentioned above.
Marks and numbers | Description of articles and of processing | Full cost or (when no charge is made) value of processing (see subchapter II, chapter 98, HTSUS) | Total value of articles after processing |
_______________________________
(Date)
_______________________________
(Address)
_______________________________
(Signature)
_______________________________
(Capacity)
I, __________, declare that the (above) (attached) declaration by the person who performed the processing abroad is true and correct to the best of my knowledge and belief; that the articles were manufactured in the United States by ________________ (name and address) or, if of foreign origin, were subjected to ________________ (show processes of manufacture, such as molding, casting, machining) in the United States by ________________ (name and address); that the articles were not manufactured or produced in the United States under subheading 9813.00.05, HTSUS; that the articles were exported for processing and without benefit of drawback from ________________ (port) on ____________, 19 ______; that the articles entered in their processed condition are otherwise the same articles that were exported on the above date and that are identified in the (above) (attached) declaration; and that the returned articles will be subjected to ________________ (describe processing to be performed in the United States) by ________________ (name and address of U.S. processor).
_______________________________
(Date)
_______________________________
(Address)
_______________________________
(Signature)
_______________________________
(Capacity)
19 C.F.R. §10.9