Form G-1041 - Genealogy Index Search Request
Download a blank fillable Form G-1041 - Genealogy Index Search Request in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form G-1041 - Genealogy Index Search Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Genealogy Index Search Request
USCIS
Form G-1041
Department of Homeland Security
OMB No. 1615-0096
U.S. Citizenship and Immigration Services
Expires 05/31/2019
►
START HERE - Type or print in black ink.
Part 1. Information About You (Requestor)
Requestor's Certification
By my signature, I consent to pay all costs incurred for search,
Requestor's Full Name
duplication, and review of documents up to $65. (See Form
G-1041 Instructions for more information.)
1.a. Family Name
(Last Name)
6.a.
Requestor's Signature
1.b.
Given Name
(First Name)
1.c.
Middle Name
6.b. Date of Signature (mm/dd/yyyy)
Requestor's Mailing Address
Part 2. Immigrant's Information
2.a.
In Care Of Name (if any)
Full Name of the Immigrant
1.a. Family Name
2.b.
Street Number
(Last Name)
and Name
1.b.
Given Name
2.c.
Apt.
Ste.
Flr.
(First Name)
1.c.
Middle Name
2.d.
City or Town
Other Names Used by the Immigrant
2.e.
State
2.f.
ZIP Code
List all other names the immigrant has ever used, including
2.g.
Province
aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 4.
2.h. Postal Code
Additional Information.
2.i.
Country
2.a. Family Name
(Last Name)
2.b.
Given Name
(First Name)
Requestor's Contact Information
2.c.
Middle Name
3.
Requestor's Daytime Telephone Number
4.
Requestor's Mobile Telephone Number (if any)
5.
Requestor's Email Address (if any)
Form G-1041 12/23/16 N
Page 1 of 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal