📄 Sample Document — Demonstration Only
This is a pre-filled example of the Lacey Act Declaration that Timberlark generates. No real company or transaction is represented.
LACEY ACT IMPORT DECLARATION
16 U.S.C. § 3372(f) — Required for all plant product imports into the United States
1. Importer Information
Importer Name
Pacific Hardwood Imports LLC
Declarant
Marcus T. Engel, VP Operations
Importer of Record (IOR)
Pacific Hardwood Imports LLC
U.S. Customs Bond No.
CBP-4821-PHIW
Importer Address
4480 Harbor Blvd, Suite 200, Portland, OR 97201, United States
2. Shipment / Transport Details
Entry Number
CBP-20260703-4821
Port of Entry
Portland, OR (PDX)
Country of Export
Vietnam
Vessel / Carrier
MV Saigon Star
Bill of Lading No.
PVNP-2026-06-0441
3. Country of Harvest / Production
Country of Harvest
Vietnam
Sub-national Region
Central Highlands (Tây Nguyên)
Concession / Origin Notes
Plantation teak (Tectona grandis) from licensed concession VC-2019-0014, operated by Viet Green Timber Co., Ltd. under Vietnamese Decree No. 156/2018/ND-CP. All harvest permits on file with processor.
4. Species Declaration
| Scientific Name |
Common Name |
Family |
CITES Appendix |
| Tectona grandis |
Plantation Teak |
Lamiaceae |
Not Listed |
| Swietenia macrophylla |
Big-leaf Mahogany |
Meliaceae |
Appendix II |
5. Product Description
Product Type
Timber / Furniture
Description of Goods
Solid wood dining tables and chairs (plantation teak). Mahogany accent inlays. Finished and packaged for retail. 240 units, 6 containers (40' HC). Part of PO#PHI-2026-0189.
6. Quantity & Value
Declared Value
USD $284,000
7. Supply Chain Information
Supply Chain Summary
Plantation teak harvested by Viet Green Timber Co., Ltd., Đắk Lắk Province, Vietnam. Processed and furniture manufactured at VGTC factory, Buôn Ma Thuột. Exported by Saigon Export Furniture JSC, Ho Chi Minh City. Imported by Pacific Hardwood Imports LLC, Portland OR. All intermediaries have signed Chain of Custody declarations available on request.
8. Declarant Statement
I, Marcus T. Engel, as authorized representative of Pacific Hardwood Imports LLC, hereby declare that the information provided in this Lacey Act Import Declaration is true, accurate, and complete to the best of my knowledge and belief.
✓ I declare that no plant material included in this shipment was harvested in violation of any applicable law or regulation of the United States, or any law or regulation of any foreign country.
✓ I understand that knowingly providing false information on this declaration is punishable under 18 U.S.C. § 1001 and may result in civil and criminal penalties under the Lacey Act, including fines of up to $50,000 and imprisonment.
⚖️ Penalty Notice: The Lacey Act (16 U.S.C. §§ 3371–3378) prohibits the import, export, transport, sale, or purchase of plants and plant products that have been illegally harvested or traded. Civil penalties up to $10,000 per violation; criminal penalties up to $500,000 and 5 years imprisonment for knowing violations.
Marcus T. Engel
Declarant — Signature
⛓ Blockchain Verified — VeChain Mainnet
Network: mainnet · Filed: July 3, 2026, 14:47:22 UTC
Tx: 0x3a9d7c4f2b8e1a6d5f0c3b7e9a2d4f1c6b8e0a3d5f7c9b1e4a6d8f0c2e4f6a8c
Data Hash: 0xa1c3e5f7b9d1f3a5c7e9b1d3f5a7c9e1f3b5d7a9c1e3f5b7d9a1c3e5f7b9d1f3a
View on VeChain Explorer →
Verify this declaration: timberlark.com/verify-lacey?stmt=TL-LACEY-20260703-3314
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