U.S. Citizenship and Immigration Services
National Records Center (NRC)
P.O. Box 648010
Lee's Summit, MO 64064-8010
RE: FOIA Request
A# (USCIS NUMBER) If applicable
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:
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 Mailing Address Or P.O.BOX