Form DSP-119 Application for Amendment to License for Export or Impor

DTC - DSP119

DSP-119:
Application for AMENDMENT to License
for Export/Import of Defense Articles
Required fields are in red and marked with an asterisk.

*Transaction ID:

*PIN:

1. *Date Prepared 2. *License Type (check one)
(mm/dd/yyyy)
DSP5

DSP61

5. Applicant Name & Address

DSP73

3. *Registration Code
DSP85

6. Applicant Contact

Phone:

6. Amendment to Blk(s) # (up to 4 )

a. *Change From (original license)

Reason for change

(1 of 4)

7. *Amendment to License #:

Change to (as it should appear)

DTC - DSP119

b. Change From (original license)

Change to (as it should appear)

Reason for change

c. Change From (original license)

Change to (as it should appear)

Reason for change

d. Change From (original license)

Reason for change

(2 of 4)

Change to (as it should appear)

DTC - DSP119

8. DIS Security Office (DSP85 Only)

9. Amendment to be sent to

10. *Applicant's Name
I,
, hereby apply for approval of the above ammendment(s);
warrant the truth of all statements made herein; and acknowledge, understand and will
comply with the provisions of Title 22 CFR 120-130 and any condiitons or limitations
implied.
Adds party such as freight fwd
Freight forwarder list attached

Applicant's Statement
The natural person submitting this application is (check one only):
a citizen of the U.S. or
lawfully admitted to the U.S. for permanent residence or
an official of a foreign government entity in the U.S.

Submit

OMB Approval No. 1405-0092

(3 of 4)

DTC - DSP119

Expiration Date: 09-30-2008
* Estimated Burden: 1/2 Hour
* Public reporting burden for this collection of information is
estimated to average 1/2 hour per response, including time required
for searching existing data sources, gathering the necessary data,
providing the information required, and reviewing the final
collection. Send comments on the accuracy of this estimate of the
burden and recommendations for reducing it to: U.S. Department of
State (A/RPS/DIR) Washington, D.C. 20520-0264, and to the Office of
Information and Regulatory Affairs, Office of Management and Budget,
Paperwork Reduction Project (1405-0023), Washington, D.C. 20520

file:///H|/Documents/DTC%20-%20DSP119.htm (4 of 4)3/11/2008 3:55:17 PM