Form 3485 Lien Notice

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

3. DATE OF NOTICE

4. DATE OF ARRIVAL

6. NAME OF CARRIER

7. B/L NO. OR CBP 7512 NO.

19 U.S.C. 66, 1564; 19 CFR 141.112
5. NAME OF CONSIGNEE/IMPORTER

8. LOCATION OF GOODS

9. MARKS AND NUMBERS

12.
AMOUNTS
CLAIMED

A. Freight

10. NO. OF PACKAGES

B. Charges

11. REMARKS

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)