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Form 4455 2019
FOR:
ALTERATION*
PROCESSING*
REPAIR*
OTHER, (specify)
USE ABROAD
REPLACEMENT
* NOTE: The cost or value of alterations, repairs, or processing
abroad is subject to customs duty.
LIST ARTICLES EXPORTED
Number
Packages
Kind of
Packages
Description
SIGNATURE OF OWNER OR AGENT (Print or Type and Sign)
DATE
The Above-Described Articles Were:
EXAMINED
DATE
PORT
SIGNATURE OF CUSTOMS OFFICER
LADEN under my supervision
DATE
PORT
SIGNATURE OF CUSTOMS OFFICER
CERTIFICATE ON RETURN
Duty-free...
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