19 U.S.C. 66, 1564; 19 CFR 141.112
LIEN NOTICE
1. PORT
3. DATE OF NOTICE
2. CBP ASSIGNED NO.
4. DATE OF ARRIVAL
6. NAME OF CARRIER
7. B/L NO. OR CBP 7512 NO.
5. NAME OF CONSIGNEE/IMPORTER
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
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.
14. NAME AND ADDRESS OF LIENHOLDER
15. STATEMENT OF CLAIMANT: The amounts claimed as due and unpaid have been satisfied.
SIGNATURE OF AGENT
DATE
SIGNATURE OF CLAIMANT
Date
DISPOSITION (CBP Use Only)
16. CBP
OFFICER
SIGNATURE
DATE
CBP Form 3485 (07/09)
Form Approved OMB No. 1651-0012. Expires 08-31-2012
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
X
X
DATE
TITLE
SIGNATURE
X
NAME
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 5 minutes. If you have any comments