DEPARTMENT OF THE TREASURYUNITED STATES CUSTOMS SERVICE

Form Approved OMS No.1515-<J063: See back of form for Paperwork Reduction Act Notice

11. Crew Member's Article No. I

CREW MEMBER'S DECLARATION19 CFR 47, 4.7a, 4.81,122.83,122.84,148.61-67 Nr K0521902

The Customs officer accepting the declaration and entry shall draw lines through unused spaces on receipt with ink.Notice: Liquidation of amount of duties and taxes, if any, due on this entry is effective on date cf payment 9f this amount (Section 159.10, CR.)For importer's right to protest or Government's right to redetermine this amount, see section 514 Tariff Act of 1930 as amended.

Customs Form 5129 (02/01)

I2. Carrier (Vessel Flag, Name) 3. Date of Arrival 4. Port of Arrival i

I

5.Crew Member's Name

I 6. Rank7. Date of Birth INSTRUCTIONS

List all articles obtained abroad and prices paid or fairvalue if not purchased. Include senal numberwith all

8. Address articles subject to registration such as cameras. radios.etc.

9. Answer Each Question: List articles to remain on board separately from thoseA. Are you carrying any fruits, B. Have you been on a C. Are you carrying over $10,000 in monetary articles to be landed in the United States.

plants, meats, other plant or farm or ranch outside instruments, such as coin, currency, travelersanimal products, birds, snails, the U.S.A. in the last checks, money orders, or negotiable instruments List separately articles intended for sale, barter,or other live organisms of any 30 days? in bearer form? (yes, you must file a report on exchange, or carried by you as an accommodation forkind? CF 4790.) someone else.

DYes D No DYes D No DYes D No See additional instructions and information on reverse.

J.To be filled in by Crew Member II. For Customs Officer's UseQuantity and Description of Goods Cost or Value of Tariff Description Value Rate Duty

Gifts,etc.I

!I

I

I

iI!

II

I certify that the above statement is a just, true and complete account of all articles of foreign origin for which written

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declaration and entry are required when landed in the United States (defined on reverse side) and I also certify that this TOTALstatement is a just, true, and complete declaration of all such articles which I am landing in the United States.

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12. Date

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RECEIPT FOR DUTY AND RELEASE SLIP Port Crew Member's Article No.

To be filled in by Crew MemberName Carrier

K0521902NrRepeat List of Articles to Be Landed (include serial numbers when appropriate) For Customs Officer's Use

Date Duty$

Articleslistedat lefthavebeenexaminedandpassed

Pieces of BaggageReleased:

of Customs

INSTRUCTIONS FOR USE

1. This declaration must be legibly prepared using pen, typewriter, or other permanent method. This declaration is required for ali articles which are to be landed by a crewmember, including any person traveling on board a vessel, vehicle, or aircraft engaged in international traffic who is returning from a trip on which the person was employedas a crew member.

2. Include serial number wijh all articles subject to registration, such as cameras, radios, etc. List articles to remain on board separately from those articles to be landed in theUnijed States. List separately articles intended for sale, barter, exchange, or carried by you as a accommodation for someone else

3. All articles acquired abroad by the particular officer or crew member shall be declared on the declaration, wijh the exception of articles exclusively for use on the voyagewhich include only necessary clothing, toiletries, and purely personal effects, and not to exceed 1 open (seal broken) liter container of alcoholic beverages, and 50 cigars, or300 cigarettes, or 2 kilos of smoking tobacco, or a proportionate amount of each, and articles which have been previously cleared through Customs and described in a properCustoms receipt release form.

4. Articles in the possession of and exclusively for use by a crew member during the voyage, such as necessary clothing, toiletries, and purely personal effects, may bebrought ashore by the crew member on temporary shore or ground leave for use while in a port without a written declaration and entry and wijhout payment of duty or internalrevenue tax ONLY if the Port Director of Customs for the port is satisfied that the articles so landed are necessary and appropriate for the crew member's accommodationwhile on temporary shore or ground leave; that they will be devoted solely to the crew member's bona fide personal use; that the quantities are reasonable, depending uponthe circumstances of each particular case; and that, in the case of tobacco products and alcoholic beverages, the container shall have been opened and the total quantitybrought ashore while the vessel is in port shali not exceed 50 cigars, 300 cigarettes, or 2 kilos of smoking tobacco, or a proportionate amount of each, and 1 liter of alcoholicbeverages. In the case of articles possessing substantial commercial value, such as cameras, watches, razors, and other articles not consumed through use, the Customsofficer concerned, before passing the articles free of duty, shall be assured beyond doubt that the article brought ashore is for the actual bona fide personal use of the crewmember while on shore or ground leave and is to be returned to the vessel or aircraft.

5. In the column headed "Cost, Or Value Of Gifts, Etc.", state in United States dollars the price actually paid for the articles, or fair value if not acquired by purchase, such as agift.

6. If additional space is needed to list all articles in column headed "Quantity and Description Of Goods", include them in another declaration form obtained from purser. Donot a~er the preprinted serial number on the declaration. (If more than one form is needed by a crew member to list articles, all serial numbers of the forms used shall benoted opposije the crew member's name on the Crew's Effects Declaration, Customs Form 1304, or the Crew List, Customs and Immigration Form 1-418).

7. If insufficient space on "Receipt for Duty And Release Slip" (lower perforated stub) to repeat the listing of all articles to be landed in the United States listed in the columnheaded "Quantity And Description of Goods", continue list on reverse side of stub.

8. This form may be printed by private parties (see footnote) as a 2-part or 3-part set for use as both a vessel's or aircraft's crew purchase manifest and the entry record forarticles landed in the Unijed States, when the vessel or aircraft is to clear directly foreign from the first port of arrival.

WARNING-PENAL TIES

The transportation of currency or monetary instruments, regardless of the amount, is legal; however, if you take out or bring into (or attempt to take out of or bring into) theUnijed States more than $10,000 (U.S. or foreign equivalent, or a combination of the two) in coin, currency, travelers checks or bearer instruments such as money orders,checks, stocks or bonds, you are required by law to file a report on a Form 4790 with the U.S. Customs Service. If you have someone else carry the currency or instrumentsfor you, you must also file the report. FAILURE TO FILE THE REQUIRED REPORT OR FALSE STATEMENTS ON THE REPORT MAY LEAD TO SEIZURE OF THECURRENCY OR INSTRUMENTS AND TO CIVIL PENALTIES AND/OR CRIMINAL PROSECUTION.

A claim for exemption from duty on an article on the false ground that it is not intended for sale and acquired or carried by the declarant as an accommodation for others willsubject the article to forfeiture.

Any article which is required to be manifested and which is not manifested is subject to forfeiture and the master of the vessel is subject to a penalty equal to the forfeijurevalue (sec. 584, Tariff Act, 1930, as amended). If any article requiring a declaration and entry when brought into the Unijed States is landed wijhout being covered by arelease slip or other permit to unlade from the Port Director of Customs, the article is subject to forfeiture, the vessel master and any other person associated wijh theunauthorized removal are subject to penalties equal to the forfeiture value, and if valued at $500 or over, the vessel itself is subject to forfeiture (sec. 453, Tariff Act, 1930).

This form may be printed by private parties, Blocks of serial numbers to be used on such forms will be furnished upon written request to the U.S. Customs~ervice, Information Services Branch, Forms Manager, Washington, DC 20229. Request should state the quantity of serial numbers needed.

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance wijh the Paperwork Reduction Notice of 1995. We ask for the information in order to carry out thelaws and regulations administered by the U.S. Customs Service, Agriculture, and currency laws of the United States. The form is used by crew members on board a vessel,vehicles, or aircraft engaged in international traffic who is arriving in the Unijed States and was employed as a crew member. It is mandatory. The estimated average burdenassociated wijh the collection of information is 3 minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimatesand suggestions for reducing this burden should be directed to U.S. Customs Service, Reports Clearance Officer, Information Services Branch, Washington, DC 20229, andto the Office of Management and Budget, Paperwork Reduction Project (1515-0063), Washington, DC 20503.

Customs Form 5129 (02/01)(Back)

Customs Form 5129 (02/01 )(Back)

""U.S. GOVERNMENT PRINTINGOFFICE. 2003-534-562