Form 3485 Lien Notice

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
LIEN NOTICE

19 U.S.C. 66, 1564; 19 CFR 141.112

5. NAME OF CONSIGNEE/IMPORTER

1. PORT

Form Approved OMB No. 1651-0012. Expires 02-28-2015
2. CBP ASSIGNED NO.

3. DATE OF NOTICE

4. DATE OF ARRIVAL

6. NAME OF CARRIER

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

8. LOCATION OF GOODS

9. MARKS AND NUMBERS

12.
AMOUNTS
CLAIMED

10. NO. OF PACKAGES

A. Freight

B. Charges

11. REMARKS

C. Contributions to General Average

D. Total

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 Protection (CBP) custody. I understand that sale of this merchandise by the Government 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 a written release or receipt showing payment of the claim in full.

X

SIGNATURE OF AGENT

DATE

14. NAME AND ADDRESS OF LIENHOLDER

X

SIGNATURE

TITLE

DATE

15. STATEMENT OF CLAIMANT: The amounts claimed as due and unpaid have been satisfied.

X

SIGNATURE OF CLAIMANT

Date
DISPOSITION (CBP Use Only)

16. CBP
OFFICER

NAME

SIGNATURE

DATE

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this
information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0012. The estimated
average time to complete this application is 15 minutes. If you have any comments regarding the burden estimate you can write to U.S. Customs and
Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form 3485 (06/12)