Cbp Form 4609 PDF Details

The Customs and Border Protection Form 4609 is a declaration form used to report the export or import of items that are controlled by the United States government. The form is used to declare the type and quantity of the item, as well as the intended destination. The form must be completed and signed by the person responsible for exporting or importing the item. Failure to complete and submit this form may result in penalties or fines.

Form NameCbp Form 4609
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namescbp, 4609, 123A456B789C0, 9th

Form Preview Example


U.S. Customs and Border Protection

OMB No. 1651-0100 Exp. 03/31/2015


NOTICE: Use this form if you want U.S. Customs and Border Protection to decide your request for the release of property and/or relief from liability incurred of the following mitigating circumstances.

INSTRUCTIONS: This form (Parts I - III) must be completed in English and signed.

In accordance with Title 19 U.S.C. 1618; CFR 171.1. I request U.S. Customs and Border Protection consider my petition for remission or mitigation from forfeiture administratively in order to obtain the release of my property.







Seizure or Penalty Number








Date of Seizure


Place of Seizure





Full Name (First, Middle, Last)











Telephone Number






INSTRUCTIONS: Provide certified copies (or originals) of all bills of sale, purchase contracts, receipts, or any other documentary evidence to establish your interest in the seized property. Failure to do so may result in denial of your petition.

NOTE: Use separate piece of paper when necessary.

A.Describe the property that was seized (i.e., 1999 Ford Truck VIN # 123A456B789C0)

B.State your interest in the seized property listed above. Are you the owner, lien holder, or otherwise?

C.State the facts and circumstances relied upon to justify relief from forfeiture. If the property was in someone else's possession at the time of seizure, please provide an explanation how it came into their possession.


A false statement contained in a petition may subject the petitioner to prosecution under the provision of 18 U.S.C. 1001.



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 1651-0100. The estimated average time to complete this application is 14 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 4609 (06/09)

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Step # 1 in submitting form

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