DescriptionSAMPLE IMMIHELP.COM CustomsDeclaration FORMAPPROVED Oil lB 1651-0009 NO. Each arriving traveler or responsiblefamily member must provide the following information only ONE wriften declaration per family is required 1. FamilyName 19CFR 22.27 148.12 148.110 148.111 31CFR 6 14S8i Ftlr. t Giorn 2. Birdr date Middle D y Month Year 3. Number of Family members traveling with you 4. a U*S* Street Address hotel ...
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