Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request (Page 4 of 7) in pdf

Item Numbers 9.a. - 12. Information About Family Members that May Appear on Requested Records. Provide

your family member’s full name and his or her relationship to you for any individual that may appear on the requested

records (for example, a spouse or children). If you need extra space to complete this section, use the space provided in

Part 5. Additional Information.

Item Numbers 13.a. - 14.d. Parents’ Names for the Subject of Record. Provide the full names of your father and

mother in the spaces provided. If applicable, include your mother’s maiden name.

Item Number 15. Description of Records Sought. Provide a description of the records you are seeking. If you need

additional space, use the space provided in Part 5. Additional Information.

Part 4. Verification of Identity and Subject of Record Consent

If you request records about yourself (in other words, you are the Subject of Record), you are required to verify your

identity by providing your full name, your current address, your date of birth, and your place of birth in Item Numbers

1.a. - 4. You must also sign this request, and you must either have your signature notarized or submitted under penalty

of perjury, which you can do by completing either Item Number 8.a. or 8.b. in this section. If you request records about

another individual (in other words, the other individual is the Subject of Record) and on behalf of that individual, you are

still required to provide a statement from the individual verifying his or her identity, as well as certifying the individual’s

agreement that USCIS may release his or her records to you. Again, you can fulfill these requirements by completing

Item Numbers 1.a. - 4. and then having the individual complete either Item Number 8.a. or 8.b.

NOTE: If you are requesting records about another individual and your request is not on behalf of that individual, you

may use the space provided in Part 5. Additional Information to provide additional information that you want USCIS

to consider in processing your request. For example, if the Subject of Record is deceased, you may use this section to

provide that information, and you should also attach appropriate proof of death, such as an obituary or a death certificate.

If you believe that the disclosure of the Subject of Record’s information would further a public interest recognizable under

the FOIA, you may also use Part 5. Additional Information to assert and explain the public interest, and you should

attach any documentation in support of your position.

Item Numbers 1.a. - 1.c. Full Name of the Subject of Record. Provide the full legal name of the Subject of Record in

the spaces provided. If you are completing this request using a computer, this information will automatically complete

based on your responses in Item Numbers 2.a. - 2.c. of Part 3.

Item Numbers 2.a. - 2.i. Mailing Address for the Subject of Record. Provide the current address of the Subject of

Record in the spaces provided. You may list a valid residence, APO, In Care Of Name, or commercial address in the

U.S. You may list a Post Office address (PO Box) if that is how the Subject of Record receives mail. If the mail is sent

to someone other than the Subject of Record, include an “In Care Of Name” as part of the mailing address. If the mailing

address is in a U.S. territory and it contains an urbanization name, list the urbanization name in the “In Care Of Name”

space provided.

Item Number 3. Date of Birth. Provide the date of birth of the Subject of Record in mm/dd/yyyy format in the space

provided.

Item Number 4. Country of Birth. Provide the name of the country where the Subject of Record was born. Provide the

name of the country as it was named when the Subject of Record was born, even if the country’s name has changed or the

country no longer exists.

Item Numbers 5. - 7. Contact Information for the Subject of Record. Provide the daytime telephone number, mobile

telephone number (if any), and email address (if any) for the Subject of Record. Providing this information is optional.

Form G-639 Instructions 04/17/17 N

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Instructions For Form G-639 - Freedom Of Information Act/privacy Act Request Page 4