Fillable G-884 Form G-884

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G-884 Form G-884

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The G-884 Form G-884 form is 3 pages long and contains:

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  • 7 check-boxes
  • 55 other fields

Country of origin: US
File type: PDF

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U.S. Citizenship and Immigration Services (USCIS) is an office of the U.S. Branch of Homeland Security (DHS) that oversees the nation's naturalization and migration framework. It is a successor to the Immigration and Naturalization Service (INS), which was disintegrated by the Homeland Security Act of 2002 and supplanted by three segments inside the DHS: USCIS, Immigration and Customs Enforcement (ICE), and Customs and Border Protection (CBP).

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Form G-884 09/19/16 N Page 1 of 3
USCIS
Form G-884
OMB No. 1615-0100
Expires 09/30/2018
►
For
USCIS
Use
Only
Remarks
Date
File No
START HERE - Type or print in black ink.
Part 1. Information About You (Person requesting the return of original documents)
IMPORTANT NOTE: You do not need to file this form if you submitted original documents because USCIS requested originals.
We will automatically return original documents that we requested once we no longer need them. Please refer to the instructions of
the form you filed to determine whether non-requested original documents are available for return or destroyed after electronic
processing.
Family Name (Last Name) Given Name (First Name) Middle Name
Your Full Name 1.
Mailing Address2.
Street Number and Name Apt. Flr. NumberSte.
City or Town
State ZIP Code
Alien Registration Number (A-Number) (if any)
►
A-
3. City/Town/Village of Birth4.
Country of Birth5. Date of Birth (mm/dd/yyyy)6. Daytime Telephone Number7.
Specific information about desired document(s) or record(s) (For example, marriage license, birth certificate,
death certificate, etc.)
8.
Request for the Return of Original Documents
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form G-884 09/19/16 N Page 2 of 3
Part 2. Data for Identification of Personal Record
Family Name (Last Name) Given Name (First Name) Middle Name
Other Names Used (if any)2.
Family Name (Last Name) Given Name (First Name) Middle Name
Subject's Full Name 1.
Date of Birth (mm/dd/yyyy)
3.
Place of Birth
4.
Port-of-Entry
6.
Type of Entry (for example, visitor, student, etc.)7. A-Number (if any)
►
A-
8.
Family Name (Last Name) Given Name (First Name) Middle Name
Name on Certificate of Naturalization9.
Certificate of Naturalization Number
10. Certificate of Naturalization Date 11.
Family Name (Last Name) Given Name (First Name) Middle Name
Name on Certificate of Citizenship12.
Certificate of Citizenship Number13.
Certificate of Citizenship Date
14.
Naturalization Court/USCIS Office and Location15.
Verification of Requester's Identity16.
Legal PhotocopiesIn Person With Identification
City or Town State or Province
Country
Date of Entry (mm/dd/yyyy)
5.
U.S. Citizenship Information
Entry Into the United States
(mm/dd/yyyy)
(mm/dd/yyyy)
Form G-884 09/19/16 N Page 3 of 3
Part 3. Signature of Requester - Affidavit of Identity
I certify, under penalty of perjury under the laws of the United States of America, that this request and evidence submitted is all true
and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to
respond to my request.
I
swear Affirm that I am the person named in Part 1. on Page 1 of this form. I understand that if I willfully make false
NOTE: Read the Penalties section of the Form G-884 Instructions before completing this part.
1.
Family Name (Last Name) Given Name (First Name) Middle Name
Print Your Full Name
statements on this form, I may be punished by fine or imprisonment (18 U.S.C. 1101).
2.
3. Signature (Your signature must be notarized. Do not sign until you are before the Certifying Official)
Date (mm/dd/yyyy)4.
I do hereby certify that the requester named in Part 1. on Page 1 of this form personally appeared before me and executed the
Affidavit of Identity.
5. Signature of USCIS Official (sign in ink)
6. Title Date (mm/dd/yyyy)7.
Family Name (Last Name) Given Name (First Name) Middle Name
Printed Name of USCIS Official8.
Certifying Official
I do hereby certify that the requester named in Part 1. on Page 1 of this form personally appeared before me and executed the
Affidavit of Identity.
Family Name (Last Name) Given Name (First Name) Middle Name
Printed Name of Certifying Official9.
10. Signature of Certifying Official (sign in ink)
11. In and for the: Date (mm/dd/yyyy)12.
Given under my hand and official seal
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G-884 Form G-884

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Completed 6 November 2019

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