UNITED STATES COURT OF INTERNATIONAL TRADE INFORMATION STATEMENT (Place an "X" in applicable [ ]) PLAINTIFF: PRECEDENCE ___________________________________________ If the action is to be given precedence under Rule 3(g), indicate the applicable paragraph of that section: ATTORNEY (Name, Address, Telephone No.): [ ] (1) [ ] (3) [ ] (5) [ ] (2) [ ] (4) [ ] (6) J U R I S D I C T I O N 28 U.S.C. § 1581(a) - Tariff Act of 1930, Section 515 - 19 U.S.C. § 1515 [ ] Appraisal [ ] Classification [ ] Charges or Exactions [ ] Exclusion [ ] Refusal to Reliquidate [ ] Liquidation [ ] Rate of Duty [ ] Vessel Repairs [ ] Drawback [ ] Redelivery 28 U.S.C. § 1581(b) - Tariff Act of 1930, Section 516 - 19 U.S.C. § 1516 [ ] Appraisal [ ] Classification [ ] Rate of Duty 28 U.S.C. § 1581(c) - Tariff Act of 1930, Section 516A(a)(1), (a)(2) or (a)(3) - 19 U.S.C. § 1516a (Provide a brief description of the administrative determination you are contesting, including the relevant Federal Register citation(s) and the product(s) involved in the determination. For Section 516A(a)(1) or (a)(2), cite the specific subparagraph and clause of the section.) Subparagraph and Clause ______________________________ Agency_______________________________ Federal Register Cite(s)____________________________________________________________________ Product(s) _________________________________________________________________________________ 28 U.S.C. § 1581(d) - Trade Act of 1974 - 19 U.S.C. §§ 2273, 2341, 2401b [ ] U.S. Secretary of Labor [ ] U.S. Secretary of Commerce [ ] U.S. Secretary of Agriculture 28 U.S.C. § 1581(e) - Trade Agreements Act of 1979, Section 305(b)(1) - 19 U.S.C. § 2515 (Provide a brief statement of the final determination to be reviewed. ) 28 U.S.C. § 1581(f) - Tariff Act of 1930, Section 777(c)(2) - 19 U.S.C. § 1677f(c)(2) Agency: [ ] U.S. International Trade Commission [ ] Administering Authority 28 U.S.C. § 1581(g) - Tariff Act of 1930, Section 641 - 19 U.S.C. § 1641 - or Section 499 19 U.S.C. § 1499 [ ] Sec. 641(b)(2) [ ] Sec. 641(c)(2) [ ] Sec. 641(b)(3) [ ] Sec. 641(d)(2)(B) [ ] Sec. 641(c)(1) [ ] Sec. 499(b) [ ] Sec. 641(b)(5) (Continued on reverse side) J U R I S D I C T I O N (Continued) American LegalNet, Inc. www.USCourtForms.com 28 U.S.C. § 1581(h) - Ruling relating to: [ [ ] Classification ] Rate of Duty [ [ ] Valuation ] Marking [ [ ] Restricted Merchandise ] Entry Requirements [ ] Drawbacks [ ] Vessel Repairs [ ] Other: ________________ _________________________________________________________________________________ 28 U.S.C. § 1581(i) - (Cite any applicable statute and provide a brief statement describing jurisdictional basis.) 28 U.S.C. § 1582 - Actions Commenced by the United States [ ] (1) Recover civil penalty under Tariff Act of 1930: [ ] Sec. 592 [ ] Sec. 641(d)(2)(A) [ [ [ ] Sec. 593A [ ] Sec. 704(i)(2) [ ] Sec. 641(b)(6) [ ] Sec. 734(i)(2) ] (2) Recover upon a bond ] (3) Recover customs duties R E L A T E D C A S E (S) To your knowledge, does this action involve a common question of law or fact with any other action(s) previously decided or now pending? PLAINTIFF [ JUDGE ] Decided: [ COURT NUMBER ] Pending: (Attach additional sheets, if necessary.) (As amended, eff. Jan. 1, 1985; Jan. 25, 2000, eff. May 1, 2000; May 25, 2004, eff. Sept. 1, 2004; Nov. 29, 2005, eff. Jan. 1, 2006.) American LegalNet, Inc. www.USCourtForms.com