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obsidian-yanxin/documents/travel/customs_declaration/customs_xue_fengqin.md
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Customs Declaration (English Version) - Xue Fengqin

U.S. Customs and Border Protection 19 CFR 122.27, 148.12, 148.13, 148.110, 148.111, 1498; 31 CFR 5316 FORM APPROVED OMB NO. 1651-0009

Each arriving traveler or responsible family member must provide the following information (only ONE written declaration per family is required):

# Field Value
1 Family Name Xue
First (Given) Fengqin
Middle
2 Birth date Day 06 Month 04 Year 65
3 Number of Family members traveling with you 2
4(a) U.S. Street Address (hotel name/destination) 1652 W 6th Street Apt. R
4(b) City Austin
4(c) State Texas
5 Passport issued by (country) China
6 Passport number G49056250
7 Country of Residence China
8 Countries visited on this trip prior to U.S. arrival China
9 Airline/Flight No. or Vessel Name HU 495

Declaration Questions

# Question Answer
10 The primary purpose of this trip is business No X
11(a) fruits, vegetables, plants, seeds, food, insects No X
11(b) meats, animals, animal/wildlife products No X
11(c) disease agents, cell cultures, snails No X
11(d) soil or have been on a farm/ranch/pasture No X
12 I have (We have) been in close proximity of (such as touching or handling) livestock No X
13 I am (We are) carrying currency or monetary instruments over $10,000 U.S. or foreign equivalent No X
14 I have (We have) commercial merchandise No X

Declared Value

Category Value
15. Residents — total value of all goods $ —
Visitors — total value of all articles that will remain in the U.S., including commercial merchandise $ 500

Read the instructions on the back of this form. Space is provided to list all the items you must declare.

I HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION.

Signature: (signed) Date: