[DATE]

U.S. Department of Justice
Executive Office for Immigration Review
Office of General Counsel - FOIA Service Center
FOIA/Privacy Act Requests
5107 Leesburg Pike, Suite 1903
Falls Church, Virginia 22041

RE:        EOIR FOIA Request
Your Name

A#: or USCIS Number if applicable

Dear Sir/Madam:

My name is Your Name  and I was born on Your Birthdate in Your country of origin.

Enclosed you will find Form DOJ-361 duly signed.  I declare, under penalty of perjury, that the information provided on the enclosed Form DOJ-361 is true and correct to the best of my knowledge and ability.  

A duly executed Form G-28 is also included. I hereby authorize to receive a copy of my entire file by mail to the following address:

        

        Your Name

Your Address Or P.O. BOX

Sincerely,

______________________

Your Name

Your Address or P.O. BOX