Form 5 Information Statement {5}

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: [ ] 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 [ ] Vessel Repairs [ ] Exclusion [ ] Liquidation [ ] Drawback [ ] Refusal to Reliquidate [ ] Rate of Duty [ ] 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 or Section 517(g) 226 19 U.S.C. 2471517 (Provide a brief description of the administrative determination you are contesting, including any relevant Federal Register or Administrative Determination 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 or Administrative Determination 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(b)(3) [ ] Sec. 641(c)(1) [ ] Sec. 641(b)(5) [ ] Sec. 641(c)(2) [ ] Sec. 641(d)(2)(B) [ ] Sec. 499(b) American LegalNet, Inc. www.FormsWorkFlow.com 28 U.S.C. ' 1581(h) - Ruling relating to: [ ] Classification [ ] Valuation [ ] Restricted Merchandise [ ] Rate of Duty [ ] Marking [ ] 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. 593A [ ] Sec. 641(b)(6) [ ] Sec. 641(d)(2)(A) [ ] Sec. 704(i)(2) [ ] 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 COURT NUMBER JUDGE [ ] Decided: [ ] 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; Sept. 18, 2018, eff. Oct. 15, 2018.) J U R I S D I C T I O N (Continued) American LegalNet, Inc. www.FormsWorkFlow.com