Form G-884 - Request For The Return Of Original Documents Page 2
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1
2Part 3. Signature of Requester
Affidavit of Identity
-
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.
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).
Print Your Full Name
Date (mm/dd/yyyy)
Signature (Your signature must be notarized. Do not sign until before the 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.
Signature of USCIS Official
Title
Date (mm/dd/yyyy)
Printed Name of USCIS Official
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.
Signature of Certifying Official
Printed Name of Certifying Official
In and for the:
Given under my hand and official seal
Date (mm/dd/yyyy)
Form G-884 (12/11/11)Y Page 2
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