Form G-1041a - Genealogy Records Request Page 2
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3Part 2. Information Needed to Release a
1.f.
Fee (Select all appropriate boxes)
Historical Record (continued)
$65 (Microfilm)
$65 (Hard Copy)
Other Information for the Immigrant
Non-standard C-Files (B, D, OM, OS, A, AA, OL)
4.a. Date of Birth (mm/dd/yyyy)
2.a.
Number as Shown on Certificate
►
4.b.
Is this date actual or estimated?
Actual
Estimated
2.b.
Date of Issuance (mm/dd/yyyy)
Place of Birth (Include Town or Village, Province, and
Country, if known)
Alien Registration Record (AR-2) (1940 - 1944)
5.a.
Town or Village
3.a.
Alien Registration Number (A-Number)
A or AR
5.b.
Province
►
5.c.
Country
3.b.
Fee
$65 (Copy Format - Microfilm)
A-File numbered below 8 million
IMPORTANT: If the immigrant's date of birth is less than
100 years prior to the date of this request, you must attach
A
4.a. A-File Number
►
documentary proof of death to the request form. Do not attach
original records because we will not return them. See the Who
4.b.
Fee
$65 (Copy Format - Hard Copy)
Should Use Form G-1041A section of these Instructions for
examples of acceptable documentary proof of death.
Visa File (1924 - 1944)
Part 3. Identification of Requested Record
5.a.
Visa Number ►
NOTE (C-file numbered C650000 and below): The fee for a
5.b.
Date of Entry (mm/dd/yyyy)
copy of a microfilm record is $65 per request.
5.c.
Port-of-Entry
NOTE (C-file numbered C650000 and below): The fee for a
copy of a textual hard copy file is $65 per request.
5.d.
Ship (seaport arrivals only)
NOTE: If you are a researcher providing a C-file number
below C-650000 obtained from any source other than the
USCIS Genealogy Program, you may not know the format of
the file (microfilm or hard copy).
5.e.
Fee
$65 (Copy Format - Hard Copy)
Naturalization Certificate File (1906 - 1956)
Registry File (1929 - 1944)
C
1.a. Certificate Number
►
6.a.
Registry File Number
► R
1.b.
Date of Naturalization (mm/dd/yyyy)
6.b. Fee
$65 (Copy Format - Hard Copy)
Total Fees Due/Attached
$
1.c.
Court
1.d.
City
1.e.
County
Form G-1041A 12/23/16 N
Page 2 of 3
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