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Get CBP 4631 2007-2024

DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection SEIZED ASSET CLAIM FORM Request for Forfeiture Proceedings in Federal Court IMPORTANT This form should be used only if you want your case referred to the United States Attorneys Office to decide your case in Federal Court. DO NOT COMPLETE THIS FORM if you want U*S* Customs and Border Protection to handle your case administratively. Name Seizure No* Address Telephone No* INSTRUCTIONS You must complete all three parts below. As authorized by 18 USC 983 a 2 A I request that the Government file a complaint for forfeiture in Federal Court against the seized property described below Part I List all the items in which you claim an interest. Include sufficient information to identify the items such as serial numbers make and model numbers aircraft tail numbers photographs and so forth. Use continuation sheet if more space is needed* State your interest in each item of property listed above. Use continuation sheet if more space is needed* Part III ATTESTATION AND OATH I attest and declare under penalty of perjury that the information provided in support of my claim is true and correct to the best of my knowledge and belief* Printed Name Signature Date A FALSE STATEMENT OR CLAIM MAY SUBJECT A PERSON TO PROSECUTION UNDER 18 U*S*C. 1001 AND/OR 1621 AND IS PUNISHABLE BY A FINE AND UP TO FIVE YEARS IMPRISONMENT. CBP Form 4631 07/07 CONTINUATION SHEET Seizure Case Number Full Name First Middle Last. DO NOT COMPLETE THIS FORM if you want U*S* Customs and Border Protection to handle your case administratively. Name Seizure No* Address Telephone No* INSTRUCTIONS You must complete all three parts below. As authorized by 18 USC 983 a 2 A I request that the Government file a complaint for forfeiture in Federal Court against the seized property described below Part I List all the items in which you claim an interest. Name Seizure No* Address Telephone No* INSTRUCTIONS You must complete all three parts below. As authorized by 18 USC 983 a 2 A I request that the Government file a complaint for forfeiture in Federal Court against the seized property described below Part I List all the items in which you claim an interest. Include sufficient information to identify the items such as serial numbers make and model numbers aircraft tail numbers photographs and so forth. Include sufficient information to identify the items such as serial numbers make and model numbers aircraft tail numbers photographs and so forth. Use continuation sheet if more space is needed* State your interest in each item of property listed above. Use continuation sheet if more space is needed* State your interest in each item of property listed above. Use continuation sheet if more space is needed* Part III ATTESTATION AND OATH I attest and declare under penalty of perjury that the information provided in support of my claim is true and correct to the best of my knowledge and belief* Printed Name Signature Date A FALSE STATEMENT OR CLAIM MAY SUBJECT A PERSON TO PROSECUTION UNDER 18 U*S*C. .

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