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, 1 148.12, 148.13, 148.110,148.111,31CFR 6 14S8i 531 Ftlr.;t (Giorn) 2. Birdr date D^y Month Middle Year 3. Number of Family members traveling with you 4. (a) U.S. Street...
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