DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection APPLICATION AND APPROVAL TO MANIPULATE, EXAMINE, SAMPLE OR TRANSFER GOODS 1. GOODS CONSIGNED TO (Name) 2. GOODS EXPORTED FROM Form Approved OMB No. 1651-0006 Exp. 07-31-2009 3. PORT/PORT CODE AND DATE OF APPLICATION 4. LOCATION OF GOODS 5. CARRIER OR SHIP (Name) 6. BILL OF LADING OR CBP 7512 NO. 7. IS AREA BONDED? 8. ENTRY INFORMATION Number: 19 CFR 19.8, 19.11, 158.43 YES NO Warehouse Consumption Date: PERMISSION IS REQUESTED TO: (Describe the complete operation to be performed under CBP supervision on the goods listed below): 9. MARKS AND NUMBERS 10. DESCRIPTION FOR CBP USE ONLY 11. MANIPULATED VALUE 12. SIGNATURE OF APPLICANT APPROVED 13. DATE 14. SIGNATURE AND TITLE OF APPROVING CBP OFFICER See Page 2 of form for Paperwork Reduction Act Notice. Customs and Border Protection Officers Report on Reverse CBP Form 3499 (10/95) CUSTOMS AND BORDER PROTECTION OFFICER'S REPORT Date: MANIPULATION COMPLETED AS REQUESTED: When goods are repacked the CBP (warehouse) officer will report hereon the marks and numbers of packages repacked and the marks and numbers of packages and the weights or guage of same after repacking. (CBP Officer and Title) PAPERWORK REDUCTION ACT NOTICE: The Paperwork Reduction says we must tell you why we are collecting this information, how we will use it, and whether you have to give it to us. We ask for the information in order to carry out U.S. Customs and Border Protection laws of the United States. This form is used by importers as an application to examine, sample, repack or transfer merchandise under CBP supervision; as a request for manipulation of merchandise in a bonded warehouse; and as an application for abandonment or destruction of merchandise in bond. It is required to obtain or retain a benefit. The estimated average burden associated with this collection of information is 6 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 Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0006), Washington, DC 20503. CBP Form 3499 (10/95)