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10.66, 10.67, 12.41, 123.4, 143.23, 145.35 1. PORT 2. DATE 3. ENTRY NO. & DATE 4. NAME OF MANUFACTURER 5. CITY AND STATE OF MANUFACTURE 6. REASON FOR RETURN 7. U.S. DRAWBACK PREVIOUSLY CLAIMED UNCLAIMED 8. PREVIOUSLY IMPORTED UNDER HTSUS 9813.00.05? YES NO 9. MARKS, NUMBERS, AND DESCRIPTION OF ARTICLES RETURNED 10. VALUE* * If the value of the article is $10,000 or more and the articles are not clearly marked with the name and address of U.S. manufacturer, please attach copies of an.

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