Free CBP Form 3485 - Lien Notice - Federal

Form Approved OMB No. 1651-0012. Expires 07-31-2009

DEPARTMENT OF HOMELAND SECURITY

1. PORT

2. CBP ASSIGNED NO.

U.S. Customs and Border Protection LIEN NOTICE
19 U.S.C. 66, 1564; 19 CFR 141.112
5. NAME OF CONSIGNEE/IMPORTER

3. DATE OF NOTICE 6. NAME OF CARRIER

4. DATE OF ARRIVAL 7. B/L NO. OR CBP 7512 NO.

8. LOCATION OF GOODS

9. MARKS AND NUMBERS

10. NO. OF PACKAGES

11. REMARKS

12. AMOUNTS CLAIMED

A. Freight

B. Charges

C. Contributions to General Average D. Total

14. NAME AND ADDRESS OF LIENHOLDER 13. STATEMENT OF AGENT I, the Undersigned, agent of the above named carrier, certify that the carrier has a lien on the above listed merchandise in accordance with Sections 564 and 613 of the Tariff Act of 1930. I further certify that the information set forth in this notice is true to the best of my knowledge and belief, and that the sum claimed is due and unpaid and was a subsisting lien upon the goods described at the time they passed into U.S. Customs and Border Date Protection (CBP) custody. I understand that sale of this merchandise by the Government 15. SIGNATURE AND TITLE OF LEINHOLDER for any reason does not entitle claimants to advance notice in the absence of a written request identifying the goods with this notice. I also, agree, upon the discharge or satisfaction of this lien, to promptly notify the CBP office at the above-named port by filing 16. STATEMENT OF CLAIMANT a written release or receipt showing payment of the claim in full. The amounts claimed as due and unpaid have been satisfied. SIGNATURE OF AGENT Date SIGNATURE OF CLAIMANT Date

DISPOSITION (CBP Use Only)

17. NAME OF CBP OFFICER

18. SIGNATURE OF CBP OFFICER

19. DATE

CBP Form 3485 (08/90)

PAPERWORK REDUCTION ACT NOTICE: The Paperwork Reduction Act says we must tell you why we are collecting this information, how we will use it, and whether you have to give it to us. Your response is mandatory. The estimated average burden associated with this collection of information is 5 minutes per respondent or recordkeeper depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Information Services Branch, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0012), Washington, DC 20503.

CBP Form 3485 (08/90)(Back)