U.S. Citizenship and Immigration Services

National Records Center (NRC)

FOIA/PA Office

P.O. Box 648010

Lee's Summit, MO 64064-8010

RE:         FOIA Request

Your Name

A# (USCIS NUMBER) If applicable

Dear Sir/Madam:

My name is Your Name. Please find enclosed a Form G-639 duly signed.

I declare, under penalty of perjury, that the information provided on the enclosed
Form G-639 and the following information is true and correct to the best of my
knowledge and ability.  

Full Name:  Your Name

Current address:  Your Address or P.O Box

Date of Birth: Your Date of Birth

Place of Birth:  Your Country of Origin

Alien Registration Number: Or also called USCIS Number if applicable


I ask that you please forward a copy of my entire file to my mailing address at the following:

        Your Name        

Your Address

Pursuant to the Privacy Act of 1974 and DHS policy, I hereby consent the disclosure to
of any record pertaining to me that appears in any system of records of USCIS, USCBP, or USICE.



Your Name

Your Mailing Address Or P.O.BOX