Form 4609 Form 4609 Petition for Remission or Mitigation of Forfeitures and

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0100
Exp. 10/31/2008

U.S. Customs and Border Protection
PETITION FOR REMISSION OR MITIGATION OF FORFEITURES
AND PENALTIES INCURRED
19 U.S.C. 1618; 19 CFR 171.1
1. PORT

2. SEIZURE OR PENALTY NO.

3. DESCRIPTION OF MERCHANDISE

5. ADDRESS

4. NAME

I petition for the release of the seized above-described merchandise and for relief from the liability incurred of the following mitigating circumstances.

6. SIGNATURE

7. ADDRESS

8. DATE

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to carry out
the laws and regulations administered by U.S. Customs and Border Protection. This form is used by persons who are requesting mitigation of a penalty or
remission of a forfeiture which has been incurred under the Customs laws or a law administered by CBP. It is required to obtain this benefit. The estimated
average burden associated with this collection of information is 14 minutes per respondent depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing this burden should be directed to the U.S. Customs and Border Protection, Information
Services Division, Washington, DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0100), Washington, DC 20503.

CBP Form 4609 (09/00)