Uscis Form G-884 - Request For The Return Of Original Documents Page 3
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3Part 3. Signature of Requester - Affidavit of Identity
NOTE: Read the Penalties section of the Form G-884 Instructions before completing this part.
I certify, under penalty of perjury under the laws of the United States of America, that this request and evidence submitted is all true
and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to
respond to my request.
1.
I
swear
Affirm that I am the person named in Part 1. on Page 1 of this form. I understand that if I willfully make false
statements on this form, I may be punished by fine or imprisonment (18 U.S.C. 1101).
2.
Print Your Full Name
Family Name (Last Name)
Given Name (First Name)
Middle Name
3.
Signature (Your signature must be notarized. Do not sign until you are before the Certifying Official)
4.
Date (mm/dd/yyyy)
I do hereby certify that the requester named in Part 1. on Page 1 of this form personally appeared before me and executed the
Affidavit of Identity.
5. Signature of USCIS Official (sign in ink)
6. Title
7.
Date (mm/dd/yyyy)
8.
Printed Name of USCIS Official
Family Name (Last Name)
Given Name (First Name)
Middle Name
Certifying Official
I do hereby certify that the requester named in Part 1. on Page 1 of this form personally appeared before me and executed the
Affidavit of Identity.
9.
Printed Name of Certifying Official
Family Name (Last Name)
Given Name (First Name)
Middle Name
10. Signature of Certifying Official (sign in ink)
11. In and for the:
12.
Date (mm/dd/yyyy)
Given under my hand and official seal
Form G-884 09/19/16 N
Page 3 of 3
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