Third Party Verification Claim

ManualsBrandsModus Furniture ManualsDressersKentfield 8-Drawer Black Drifted Oak Dresser 38 in. H x 62 in. W x 18 in. D

According to the Paperwork reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control

OMB APPROVED

number. The valid OMB control number for this information collection is 0579-0349. The time required to complete this information collection is estimated to average 0.5 hours per response,

0579-0349

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Exp. Date:

SECTION 1 - Shipment Information

1.ESTIMATED DATE OF ARRIVAL:(MM/DD/YYYY) 6.IMPORTER NAME:

April 17, 2020 Modus Furniture International

2.ENTRY NUMBER: 7.IMPORTER ADDRESS:

5410 Mc Connell Avenue

Los Angeles, CA 90066 U.S.A

3.CONTAINER NUMBER:

MSKU9417855

8.CONSIGNEE NAME:

4.BILL OF LADING:

: Mancini's Sleep World (Agency)

MAEU592213037

10.DESCRIPTION OF MERCHANDISE:

9.CONSIGNEE ADDRESS:

5.MID:

18,018.00 599 Hawthorne Place

Livermore , CA 94550 USA

Phone : 925-456-6400

Fax : 925-456-6440

SECTION 2-Compliance with Lacey Act Requirements(16 U.S.C.3372(f))

For each article or component of an article, provide the following:

12.ENTERED VALUE: 16.QUANTITY OF 17.UNIT

(in U.S.Dollars) Genus Species PLANT MATERIAL

9403.50.9045

NEVIS PF FL HB+FB ESPRESSO SPECIAL MDF MALAYSIA 0.1047

m3 0%

9403.50.9045

NEVIS PF FL HB+FB ESPRESSO Swietenia Macrophylla Indonesia 0.1021

m3 0%

9403.50.9045

NEVIS PF EK HB+FB ESPRESSO SPECIAL MDF MALAYSIA 0.0897

m3 0%

9403.50.9045

NEVIS PF EK HB+FB ESPRESSO Swietenia Macrophylla Indonesia 0.0681

m3 0%

9403.50.9080

NEVIS 7 DRW DRESSER ESPRESSO albizia lebbeck Indonesia 0.1832

m3 0%

9403.50.9080

NEVIS 7 DRW DRESSER ESPRESSO SHOREA Laevis Ridl INDONESIA 0.1832

m3 0%

9403.50.9080

NEVIS 7 DRW DRESSER ESPRESSO SPECIAL MDF MALAYSIA 0.1826

m3 0%

9403.50.9080

NEVIS 7 DRW DRESSER ESPRESSO SPECIAL PARTICLEBOARD THAILAND 0.1063

m3 0%

9403.50.9080

NEVIS 7 DRW DRESSER ESPRESSO Swietenia Macrophylla Indonesia 0.1190

m3 0%

9403.50.9080

NEVIS 5 DRW CHEST ESPRESSO albizia lebbeck Indonesia 0.2359

m3 0%

9403.50.9080

NEVIS 5 DRW CHEST ESPRESSO SHOREA Laevis Ridl INDONESIA 0.2359

m3 0%

9403.50.9080

NEVIS 5 DRW CHEST ESPRESSO SPECIAL MDF MALAYSIA 0.5620

m3 0%

9403.50.9080

NEVIS 5 DRW CHEST ESPRESSO SPECIAL PARTICLEBOARD THAILAND 0.3077

m3 0%

9403.50.9080

NEVIS 5 DRW CHEST ESPRESSO Swietenia Macrophylla Indonesia 0.3824

m3 0%

9403.50.9045

RIVA PF QN HB+FB ESPRESSO SPECIAL MDF MALAYSIA 0.0727

m3 0%

9403.50.9045

RIVA PF QN HB+FB ESPRESSO SPECIAL PARTICLEBOARD THAILAND 0.0188

m3 0%

9403.50.9045

RIVA PF QN HB+FB ESPRESSO Swietenia Macrophylla INDONESIA 0.1620

m3 0%

9403.50.9045

RIVA PF EK HB+FB ESPRESSO SPECIAL MDF MALAYSIA 0.0911

m3 0%

9403.50.9045

RIVA PF EK HB+FB ESPRESSO SPECIAL PARTICLEBOARD THAILAND 0.0232

m3 0%

9403.50.9045

RIVA PF EK HB+FB ESPRESSO Swietenia Macrophylla INDONESIA 0.1844

m3 0%

9403.50.9045

ROLL SLAT 12 PC QN POPULUS DELTOIDES CHINA 0.4375

m3 0%

11.HTSUS NUMBER:

13.ARTICLE/COMPONENT OF

14.PLANT SCIENTIFIC NAME:

Plant and Plant Product

Declaration Form

Section 3: Lacey Act Amendment (16 U.S.C. 3372)

U.S.DEPARTMENT OF AGRICULTURE

15.COUNTRY OF

18. PERCENT RECYCLED

(no dashes/symbols)

ARTICLE

HARVEST:

MATERIAL:

Summary of content (5 pages)

PAGE 1
According to the Paperwork reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control OMB APPROVED number. The valid OMB control number for this information collection is 0579-0349. The time required to complete this information collection is estimated to average 0.
PAGE 2
9403.50.9045 ROLL SLAT 14 PC CK POPULUS DELTOIDES CHINA 0.2726 m3 0% 9403.50.9045 ROLL SLAT 12 PC EK POPULUS DELTOIDES CHINA 0.4312 m3 0% 9403.50.9045 BRIGHTON SLG EK HB CINNAMON SPECIAL MDF MALAYSIA 0.0399 m3 0% 9403.50.9045 BRIGHTON SLG EK HB CINNAMON SPECIAL PARTICLEBOARD THAILAND 0.0254 m3 0% 0.2145 m3 0% 0% 9403.50.9045 BRIGHTON SLG EK HB CINNAMON Swietenia Macrophylla Indonesia 9403.50.9045 BRIGHTON SLG LP EK FB CINNAMON SPECIAL MDF MALAYSIA 0.
PAGE 3
9403.50.9045 NEVIS PNL LP STRG EK HB+FB ESPRESSO SPECIAL PARTICLEBOARD THAILAND 0.0599 m3 0% 9403.50.9045 NEVIS PNL LP STRG EK HB+FB ESPRESSO Swietenia Macrophylla Indonesia 0.0819 m3 0% 9403.50.9045 CITY_II STRG FL HB+FB COCO POPULUS DELTOIDES CHINA 0.0337 m3 0% 9403.50.9045 CITY_II STRG FL HB+FB COCO SPECIAL MDF MALAYSIA 0.0151 m3 0% 0.0264 m3 0% 0% 9403.50.9045 CITY_II STRG FL HB+FB COCO SPECIAL PARTICLEBOARD THAILAND 9403.50.
PAGE 4
9403.50.9045 CITY_II LP EK HB_DLP+FB BASALT_GREY POPULUS DELTOIDES CHINA 0.0116 m3 0% 9403.50.9045 CITY_II LP EK HB_DLP+FB BASALT_GREY SPECIAL MDF MALAYSIA 0.0072 m3 0% 9403.50.9045 CITY_II LP EK HB_DLP+FB BASALT_GREY SPECIAL PARTICLEBOARD THAILAND 0.0126 m3 0% 9403.50.9045 CITY_II LP EK HB_DLP+FB BASALT_GREY Swietenia Macrophylla Indonesia 0.0969 m3 0% 0.0132 m3 0% 0% 9403.50.9080 CITY_II NS PWRO BASALT_GREY albizia lebbeck Indonesia 9403.50.
PAGE 5
produce the product varies, and the species used to produce the product is unknown, enter each species that may have been used to produce the product. If product was manufactured prior to the Amendment and you cannot determine species, enter "Special" for Genus and PreAmendment for Species. The Scientific Name is NOT the trade/common name of the plant. 15. Country of Harvest: Enter the country where the plant was harvested (example: See below).