Fillable Form G-639, Freedom of: Information/Privacy Act Request (ILW.COM)

Fill Online, Printable, Fillable, Blank Form G-639, Freedom of: Information/Privacy Act Request (ILW.COM) Form

Use Fill to complete blank online ILW.COM pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form G-639, Freedom of: Information/Privacy Act Request (ILW.COM)

On average this form takes 14 minutes to complete

The Form G-639, Freedom of: Information/Privacy Act Request (ILW.COM) form is 2 pages long and contains:

  • 0 signatures
  • 9 check-boxes
  • 50 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your ILW.COM forms online.

BROWSE ILW.COM FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Form G-639, Freedom of
Information/Privacy Act Request
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0102; Expires 10/31/10
1. Type of Request (Check appropriate box)
NOTE: Use of this form is optional. Any written format for a Freedom of Information or Privacy Act request is acceptable.
2. Requester Information
3. Consent to Release Information (Complete if person is different from requester.) (Numbers 7 and 8 must be completed.)
START HERE - Type or print in black ink. Read instructions before completing this form.
Name of Requester (Last, First, and Middle Names) Date (mm/dd/yyyy) Daytime Telephone
Address (Street Number and Name) Apt. Number
City State Zip Code
Privacy Act (PA) (Number 6 must be completed in addition to all other applicable items.)
Freedom of Information Act (FOIA) (Complete all items except Number 6.)
Amendment of Record (PA only) (Number 5 must be completed in addition to all other applicable items.)
Signature of requester:
By my signature, I consent to pay all costs incurred for search, duplication and review of materials up to $25 (See instructions)
Deceased Subject - Proof of death must be attached (Obituary, Death Certificate, or other proof of death required)
Print Name of Person/Record Subject Giving Consent Signature of Person Giving Consent (Original signature required)
All of my records A portion of my records (If a portion, specify below what part, i.e., copy of application.)
By my signature, I consent to allow the requester named in Number 2 above to review (Check applicable box):
(Consent is required for records of U. S. citizens (USC) and lawful permanent residents (LPR).)
Identify the documents, records, or information you are seeking. Be as specific as possible.
Purpose: (Optional: You are not required to state the purpose of your request. However, doing so may assist USCIS in locating the
records needed to respond to your request.)
*Family Name (Last Name) Given Name (First Name) Middle Name
4. Information Needed to Search for Record(s)
5. Data Needed on Subject of Record (Note: Items marked with an asterisk (*) must be provided if known.)
Form G-639 (02/04/09) N
Form G-639 (02/04/09) N Page 2
Names of other family members that may appear on requested record(s) (i.e., spouse, daughter, son):
*Father's Name: Given Name (First Name) Middle Name Family Name (Last Name)
*Family Member's Name: Given Name (First Name) Middle Name Family Name (Last Name) Relationship
*Mother's Name: Given Name (First Name) Middle Name Family Name (Last Name) (including Maiden Name)
Manner of Entry (Air, Sea, Land) Mode of Travel (Name of Carrier)
Country of Origin (Place of Departure) Port of Entry Into the U.S. Date of Entry (mm/dd/yyyy)
*Other Names Used (if any) * Name at time of entry into the U.S. I-94 Admission #
*Alien Registration Number (A#) * Petition or Claim Receipt # * Country of Birth *Date of Birth (mm/dd/yyyy)
Other (Specify):In-Person With ID Notarized Affidavit of Identity
Telephone No.
Date (mm/dd/yyyy)(Original signature required):
My Commission Expires onSignature of Notary
Signature Signature
Subscribed and sworn to before me this day of in the year
Executed in the United States
NOTE: If a declaration is provided in lieu of a notarized signature, it must state at a minimum the following (include notary seal or
stamp in the appropriate space below):
If executed within the United States, its territories, possessions,
or commonwealths: ''I declare (certify, verify, or state) under
penalty of perjury that the foregoing is true and correct.
If executed outside the United States: ''I declare (certify,
verify, or state) under penalty of perjury under the laws of the
United States of America that the foregoing is true and correct.
Executed outside the United States
Seal or Stamp Seal or Stamp
5. Data Needed on Subject of Record (Continued)
6. Verification of Subject of Record's Identity (See instructions for explanation. Check one box.)
7. Signature of Subject of Record
8. Notary (Normally needed from persons who are the subject of the record sought or for a sworn declaration under
penalty of perjury. See below.)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form G-639, Freedom of: InformationPrivacy Act Request (ILW.COM)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 9 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document