PASSPORT FILE REQUEST
INSTRUCTIONS Complete items 1 thru 7 below. You must provide the applicant's last name, first name and middle name (or initial, if known) or
passport number. Item 6 must be completed in full. Failure to provide this information will result in a "No Record" response or request for additional
information. In cases where there is a change of name, or also known as name, give both previous and new names.
In item 7, check only those blocks for information required to satisfy request. Use REMARKS to request: information regarding inclusions; other types
of information/documents; microfilm copy or color copy of application (and justify need). SUBMIT 3 COPIES OF THIS FORM.
Passport Application Information:
1. Name (Last, First, MI)
2. Date of Birth
3. Place of Birth
4. PPT. Number
5. Control Point
6. Requested By:
A. Name
C. Date of Request
D. Time of Request
Issue Date
7. Information to be:
Verified or Furnished Below
Name
Passport Number
File Address(1)
File Address
(2)
File Address(3)
DS-1173
03-2007
A.
B.
Date of Birth
C.
D. Sex:
Female
Male
Place of Birth
E.
8. Automated Search Report:
Computer Index
Not found. Forward to Manual Files
COM Index
Microfilmed Application
Retriever
Date (mm-dd-yyyy)
(mm-dd-yyyy)
(mm-dd-yyyy)
9. Manual Search Report:
Current File
Regular File
Subjective File
Classified File
Classified Subjective
Vital Records (R/B.CLN,CWM)
No Record PT/S/RM
No Record. Forward to WNRC.
File Charged to
Searcher
Date (mm-dd-yyyy)
10. WNRC Search Report:
Searcher
Date (mm-dd-yyyy)
11. Remarks/Type and Date of Documents Desired:
(mm-dd-yyyy)
B. Agency
P.C. File
Subjective File (up to 1950)
Jul. 1974-Aug. 1977---------59-800051
Jan. 1973-June 1974---------59-79-0012
Jan. 1971-Dec. 1972---------59-74-040
Jan. 1969-Dec. 1970---------59-73-9
Jan. 1966-Dec. 1968---------71-A-2335
Dec. 1961-Dec. 1965--------68-A-4920
Nov. 1958-Nov. 1961--------66-A-603
Birth Report to Jan. 1940
No Record
Previous Passport Issuances
File Charged to
Jun. 1955-Oct. 1958---------2-A-200
Jan. 1941-May 1955---------59-A-37
Apr. 1925-Dec. 1940---------52-A-419
Jan. 1999-Jun. 2000--------59-00-0244
Jun. 2000-Mar. 2001--------59-01-0185
Mar. 2001-Aug. 2001-------59-01-0214
Aug. 2001-Nov. 2001-------59-02-0004
Nov. 2001-Feb. 2002--------59-02-0067
Feb. 2002-Sep. 2002--------59-02-0217
Feb. 2002-Jan. 2003--------59-03-0048
Sep. 2002-Jan. 2003--------59-03-0049
F.
(1)
(2)
(3)
G.
Issue Date
(mm-dd-yyyy)
Other (Explained Justified in Remarks)
(mm-dd-yyyy)
U.S. Department of State
