Form G-639, Freedom Of Information
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2OMB No. 1615-0102; Expires 01/31/2015
Form G-639, Freedom of
Department of Homeland Security
Information/Privacy Act Request
U.S. Citizenship and Immigration Services
NOTE:
Use of this form is optional. Any written format for a Freedom of Information or Privacy Act request is acceptable.
START HERE - Type or print in black ink. Read instructions before completing this form.
1. Type of Request (Check appropriate box. NOTE: If you are filing this request for records on behalf of another
individual, please respond to Number 1 as it would apply to that individual.)
Freedom of Information Act (FOIA): I am not a U.S. citizen/Lawful Permanent Resident and I am requesting my own records.
Freedom of Information Act (FOIA): I am a U.S. citizen/Lawful Permanent Resident and I am requesting documents other than
my own records.
Privacy Act (PA): I am a U.S. citizen/Lawful Permanent Resident and I am requesting my own records.
Amendment of Record (PA only): I am a U.S. citizen/Lawful Permanent Resident and I am requesting amendment of my own
records.
Other:
N/A
2. Description of Record(s) Requested:
NOTE: While you are not required to respond to all items in Number 2, failure to provide complete and specific information as
requested may result in a delay in processing or an inability to locate the record(s) or information requested.
Complete Alien File (A-File)
Other (please specify):
Any and all Form I-485 records with the name Martin Baitan
Purpose:
(Optional: You are not required to state the purpose of your request. However, doing so may assist USCIS in locating the
record(s) needed to respond to your request.)
To establish evidence when my brother initially applied to adjust status
Family Name (Last Name)
Given Name (First Name)
Middle Name
Baitan
Martin
N/A
Other Names Used (if any)
Name at time of entry into the U.S.
I-94 Admission #
Marty Baitan
Martin Baitan
742-83203601
Alien Registration Number (A#)
Petition or Claim Receipt #
Country of Birth
Date of Birth (mm/dd/yyyy)
000001001
SRC1234567
Philippines
01/01/1955
Names of other family members that may appear on requested record(s) (i.e., spouse, daughter, son):
Family Member's Name: Given Name (First Name) Middle Name
Family Name (Last Name)
Relationship
John Paul
N/A
Baitan
Brother
Father's Name: Given Name (First Name)
Middle Name
Family Name (Last Name)
Joshua
James
Baitan
Mother's Name: Given Name (First Name) Middle Name
Family Name (Last Name, including Maiden Name)
Angelica
N/A
Baitan, Villanueva
Country of Origin (Place of Departure)
Port of Entry Into the U.S.
Date of Entry (mm/dd/yyyy)
Philippines
San Diego, CA-Airport
09/13/1991
Manner of Entry (Air, Sea, Land)
Mode of Travel (Name of Carrier)
Air
United Airlines
Form G-639 (01/29/12) N Page 1
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