DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection REPORT OF DIVERSION
19 CFR 4.91 (a) and (b)
1. PORT WHICH GRANTED CLEARANCE OR PERMIT TO PROCEED 2. NATIONALITY (American or Foreign) 3. NAME OF VESSEL 5. DATE
CBP PORT DIRECTOR
OMB No. 1651-0025 Exp. 11-30-2017
4. RIG
6. NAME OF PORT TO WHICH CLEARED 7. DATE OF CLEARANCE 8. ACTUAL/EXPECTED PORT OF ARRIVAL 9. DATE OF ARRIVAL
PLEASE NOTIFY THE PORT DIRECTOR AT THE PORT OF ARRIVAL. (The port director will act only when timely notified under section 4.91(a), and 4.91(b), of the Customs Regulations)
AND/OR
GRANT RELIEF FROM ANY PENALTY TO WHICH THE MASTER OWNER OR AGENT MAY BE LIABLE UNDER 46 U.S.C. 91 CR 19 U.S.C. 1445.
10. REASONS
11. REPORT SUBMITTED BY
14. PENALTY CASE NUMBER
16. PENALTY ASSESSED AGAINST
18. RECOMMEND THAT THE PENALTY BE
19. CBP PORT DIRECTOR BY
21. PURSUANT TO THE AUTHORITY CONTAINED IN 19 U.S.C. 1618 OR 46 U.S.C. 7, THE ABOVE PENALTY IS
Remitted Mitigated to
NOTE: No notice of remission will be furnished. If no notice is received within 30 days, the petitioner may presume that penalty has been remitted.
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 1651-0025. The estimated average time to complete this application is 5 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, 90 K Street, NE., Washington DC 20229.
12. TITLE (Owner, Master, or Agent)
Port
17. SECTION OF LAW VIOLATED
13. DATE
15. AMOUNT OF PENALTY
$
20. DATE
Remitted Mitigated to
$
$
22. SIGNATURE OF CBP PORT DIRECTOR BY
23. DATE