DEPARTMENT OF THE TREASURY 
United States Customs Service

19 U.S.C. 1618; 19 CFR 171.1

OMB No. 1515-0052

1. PORT

3. DESCRIPTION OF MERCHANDISE

2. SEIZURE OR PENALTY NO.

4. NAME

5. ADDRESS

PETITION FOR REMISSION OR MITIGATION OF FORFEITURES AND PENALTIES INCURRED

(This is a mandatory field)

Any data typed after screen scrolls will not print.

DEPARTMENT OF THE TREASURY
UNITED STATES CUSTOMS SERVICE. Petition for Remission or Mitigation of Forfeitures and Penalties Incurred. 19 U S C 16 18; 
19 C F R 171.1 O M B Number 15 15-00 52 Any Data Typed after screen scrolls will not print.

Customs Form 4609 (09/00)

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