Fillable Printable Cbp Form 6043
Fillable Printable Cbp Form 6043
Cbp Form 6043
Form Approved OMB No. 1651-0081 Exp. 09-31-2019
CBP Form 6043 (09/16)
DELIVERY TICKET
PORT
ENTRY NUMBER (IT, G.O., Detention, SZ, Other, Describe)
19 CFR 4.34, 4.37, 19.9; 19 USC 1551a, 1565
TRANSFER CARTAGE RELEASE
GOODS DELIVERED TO
GOODS DELIVERED FROM (Pier, Station, Airport, etc.)
DATE OF ENTRY
DATE OF ARRIVAL
NAME AND ADDRESS OF CONSIGNEE AIR WAYBILL OR BILL OF LADING NO.
NAME OF IMPORTING CARRIER (If Airline, Give Airline and Flt. No.)
LIEN NO. DATE OF LIEN LIEN FILED BY
LIEN SATISFIED (19 USC 1564)
DATE
ENTRY SALE
DESTROYED
MARKS AND NUMBERS
CONT. NUMBER, PIECE COUNT
DESCRIPTION OF MERCHANDISE
CONDITION, WEIGHTS, ETC.
TOTAL NO. OF PACKAGES / UNITS
SIGNATURE OF CONSIGNEE
Delivered in good condition except as noted Received in good condition except as noted
QUANTITY DISCREPANCIES NOTE HERE:
VEHICLE LICENSE PLATE NUMBER
C.H. LICENSE NUMBER
DELIVERING CBP OFFICER
DELIVERING PROPRIETOR
CUSTODIAL BOND NUMBER OF DELIVERING PARTY (19 CFR 113.63)
TRUCK NUMBER
DATE TIME
COMPANY NAME AND SIGNATURE OF CARTMAN/ LIGHTERMAN/
COMMON CARRIER
RECEIVING CBP OFFICER
DATE
TIME
RECEIVING PROPRIETOR
Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond
to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is
1651-0081. The estimated average time to complete this application is 20 minutes. If you have any comments regarding the burden estimate
you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 10th Floor, 90 K Street NE, Washington DC
20229-1177.
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
