Uscis Form G-639 - Freedom Of Information/privacy Act Request Page 4
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45.a.
Page Number
5.b.
Part Number
5.c.
Item Number
Part 5. Additional Information
If you need extra space to provide any additional information
5.d.
within this request, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with your request or attach a separate sheet
of paper. Type or print the name of the Subject of Record and
his or her A-Number (if any) at the top of each sheet; indicate
the Page Number, Part Number, and Item Number to which
the information refers; and sign and date each sheet.
1.a. Family Name
(Last Name)
1.b.
Given Name
(First Name)
1.c.
Middle Name
2.
Alien Registration Number (A-Number) (if any)
►
A-
3.a.
Page Number
3.b.
Part Number
3.c.
Item Number
3.d.
6.a.
Page Number
6.b.
Part Number
6.c.
Item Number
6.d.
4.a.
Page Number
4.b.
Part Number
4.c.
Item Number
4.d.
Form G-639 03/31/15 N
Page 4 of 4
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