Official Federal Forms > US Court Of International Trade
Form 5 Information Statement 5 - Official Federal Forms
| Form 5 Information Statement Form. This is a national form and can be used in US Court Of International Trade . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
FORM 5 UNITED STATES COURT OF INTERNATIONAL TRADE INFORMATION STATEMENT (Place an "X" in applicable [ ]) PLAINTIFF: ___________________________________________ ATTORNEY (Name, Address, Telephone No.): CONSTITUTIONAL ISSUE - 28 U.S.C. ' 255 If this action raises an issue of the constitutionality of an Act of Congress, a proclamation of the President or an Executive order, check this box: [ ] JURISDICTION 28 U.S.C. ' 1581(a) - Tariff Act of 1930, Section 515 - 19 U.S.C. ' 1515 [ ] Appraisal [ ] Exclusion [ ] Refusal to Reliquidate [ ] Classification [ ] Liquidation [ ] Rate of Duty [ ] Charges or Exactions [ ] Drawback [ ] Redelivery [ ] Vessel Repairs 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(c)(1) [ ] Sec. 641(b)(5) [ ] Sec. 641(d)(2)(B) [ ] Sec. 499(b) American LegalNet, Inc. www.FormsWorkFlow.com JURISDICTION (Continued) 28 U.S.C. ' 1581(h) - Ruling relating to: [ ] Classification [ ] Rate of Duty [ ] Drawbacks [ ] Valuation [ ] Marking [ ] Vessel Repairs [ ] Restricted Merchandise [ ] Entry Requirements [ ] 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) [ ] (2) Recover upon a bond [ ] (3) Recover customs duties [ ] Sec. 593A [ ] Sec. 704(i)(2) [ ] Sec. 641(b)(6) [ ] Sec. 734(i)(2) RELATED 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 [ ] Decided: COURT NUMBER JUDGE [ ] 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; Nov. 28, 2006, eff. Jan. 1, 2007; Dec. 4, 2012, eff. Jan. 1, 2013.) American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
