Form G-884 Request for the Return of Original Documents

Request for the Return of Original Documents

USCIS
Form G-884

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0100
Expires 09/30/2018

Remarks

File No
Date

For
USCIS
Use
Only

DRAFT
Not for
Production
06/18/2018

► 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 request if
you submitted original documents because U.S. Citizenship and
Immigration Services (USCIS) requested originals. We will
automatically return original documents that we requested once
we no longer need them. Please refer to the instructions for the
form you filed to determine whether non-requested original
documents are available for return or destroyed after electronic
processing.

Your Full Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name

Mailing Address

4.

USCIS Online Account Number (if any)
►

5.

City/Town/Village of Birth

6.

Country of Birth

7.

Date of Birth (mm/dd/yyyy)

8.

Provide specific information about the desired documents
or records (for example, marriage license, birth certificate,
or death certificate).

9.

Receipt Number (if any)

(USPS ZIP Code Lookup)

2.a. In Care Of Name

►
2.b. Street Number
and Name
2.c.

Apt.

Ste.

Flr.

Part 2. Data for Identification of Personal
Record

2.d. Number

Subject's Full Name
2.e. City or Town
2.f.

State

2.g. ZIP Code

Other Information
3.

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name

Alien Registration Number (A-Number) (if any)
► A-

Form G-884 09/19/16

Page 1 of 6

Part 2. Data for Identification of Personal
Record (continued)
Other Names Used (if any)
Provide all other names the subject has ever used, including
aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 6.
Additional Information.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)
3.c. Middle Name

U.S. Citizenship Information
Name on Certificate of Naturalization
10.a. Family Name
(Last Name)
10.b. Given Name
(First Name)
10.c. Middle Name

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11.

Certificate of Naturalization Number

12.

Certificate of Naturalization Date (mm/dd/yyyy)

Name on Certificate of Citizenship

13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)

13.c. Middle Name

Birth Information
4.

14.

Certificate of Citizenship Number

Date of Birth (mm/dd/yyyy)

15. Certificate of Citizenship Date (mm/dd/yyyy)

Place of Birth
5.a. City or Town

Naturalization Court/USCIS Office and Location

5.b. State or Province

5.c. Country

16.a. Naturalization Court/USCIS Office and Location

16.b. City or Town
16.c. State

Entry Into the United States

17.

Verification of Requestor's Identity

6.

Date of Entry (mm/dd/yyyy)

In Person With Identification

7.

Port-of-Entry

Legal Photocopies

8.

Type of Entry (for example, visitor, student, etc.)

9.

A-Number (if any)
► A-

Form G-884 09/19/16

Page 2 of 6

Interpreter's Signature

Part 3. Interpreter's Contact Information,
Certification, and Signature

7.a. Interpreter's Signature

Provide the following information about the interpreter.
7.b. Date of Signature (mm/dd/yyyy)

Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)

Part 4. Contact Information, Declaration, and
Signature of the Person Preparing this Request,
if Other Than the Requestor

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1.b. Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name (if any)

Provide the following information about the preparer.

Preparer's Full Name

1.a. Preparer's Family Name (Last Name)

Interpreter's Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

Ste.

3.c. City or Town
3.d. State
3.f.

1.b. Preparer's Given Name (First Name)

Province

3.g. Postal Code
3.h. Country

Flr.

2.

Preparer's Business or Organization Name (if any)

3.e. ZIP Code

Preparer's Mailing Address

3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

3.c. City or Town

Interpreter's Contact Information

3.d. State

4.

Interpreter's Daytime Telephone Number

3.f.

5.

Interpreter's Mobile Telephone Number (if any)

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

6.

Interpreter's Email Address (if any)

Preparer's Contact Information
Interpreter's Certification

4.

Preparer's Daytime Telephone Number

5.

Preparer's Mobile Telephone Number (if any)

6.

Preparer's Email Address (if any)

I certify, under penalty or perjury, that:
I am fluent in English and

, which

is the same language specified in Part 5., Item Number 1.b.,
and I have read every question and instruction on this request
and his or her answer to every question to this requestor in the
identified language. The requestor informed me that he or she
understands every instruction, question, and answer on the
request, including the Requestor's Declaration and
Certification, and has verified the accuracy of every answer.
Form G-884 09/19/16

Page 3 of 6

Part 4. Contact Information, Declaration, and
Signature of the Person Preparing this Request,
if Other Than the Requestor (continued)
Preparer's Statement
7.a.

I am not an attorney or accredited representative but
have prepared this request on behalf of the requestor
and with the requestor's consent.

7.b.

I am an attorney or accredited representative and my
representation of the requestor in this case
extends
does not extend beyond the
preparation of this request.

Do not sign Part 5. until you are before the
Certifying Official.
Part 5. Requestor's Declaration, Certification,
Signature, and Affidavit of Identity
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.

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1.a.

I can read and understand English, and have read and
understand every question and instruction on this
request and my answer to every question.

1.b.

The interpreter named in Part 3. read to me every
question and instruction on this request and my
answer to every question in

NOTE: If you are an attorney or accredited representative, you
may need to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, with this
request.

Preparer's Certification

By my signature, I certify, under penalty of perjury, that I
prepared this form at the request of the requestor. The requestor
then reviewed this completed form and informed me that he or
she understands all of the information contained in, and
submitted with, his or her request, including the Requestor's
Declaration and Certification, and that all of this information
is complete, true, and correct. I completed this form based only
on information that the requestor provided to me or authorized
me to obtain or use.

,

a language in which I am fluent, and I understood
everything.

2.

At my request, the preparer named in Part 4.,

,

prepared this request for me based only upon
information I provided or authorized.

Requestor's Contact Information

3.

Requestor's Daytime Telephone Number

4.

Requestor's Mobile Telephone Number (if any)

5.

Requestor's Email Address (if any)

Preparer's Signature

8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Requestor's Declaration and Certification
Copies of any documents I have submitted are exact
photocopies of unaltered, original documents, and I understand
that USCIS may require that I submit original documents to
verify my identity and my authority to obtain the desired
documents or records. I authorize the release of any
information from my records that USCIS needs in order to
respond to my request.
I certify, under penalty of perjury, that I reviewed and
understand all of the information contained in, and submitted
with, my request and that all of this information is complete,
true, and correct
I swear that I am the person named in Part 1. of this request. I
understand that if I falsify or conceal a material fact or submit a
false document with this request that USCIS will deny it, deny
any other immigration benefit, and that I may face severe
penalties provided by law and may be subject to criminal
prosecution, fine, or imprisonment (18 U.S.C. 1101).

Form G-884 09/19/16

Page 4 of 6

Part 5. Requestor's Declaration, Certification,
Signature, and Affidavit of Identity (continued)

12.a. Signature of Certifying Official (sign in ink)

Requestor's Printed Full Name

12.b. Date of Signature (mm/dd/yyyy)

6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)

13.

6.c. Middle Name

In and for the:

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7.a. Signature (Your signature must be notarized. Do not
sign until you are before the Certifying Official.)

Given under my hand and official seal

7.b. Date of Signature (mm/dd/yyyy)

I do hereby certify that the requestor named in Part 1. of this
request personally appeared before me and executed the
Affidavit of Identity.
Printed Name of USCIS Official
8.a. Family Name
(Last Name)
8.b. Given Name
(First Name)
8.c. Middle Name
9.

Title of USCIS Official

10.a. Signature of USCIS Official (Sign in ink.)

10.b. Date of Signature (mm/dd/yyyy)

Certifying Official
I do hereby certify that the requestor named in Part 1. of this
request personally appeared before me and executed the
Affidavit of Identity.
Printed Name of Certifying Official
11.a. Family Name
(Last Name)
11.b. Given Name
(First Name)
11.c. Middle Name

Form G-884 09/19/16

Page 5 of 6

5.a. Page Number

Part 6. Additional Information
If you need extra space to provide any additional information
within this request, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this form or attach a separate sheet of
paper. Type or print your name at the top of each sheet;
indicate the Page Number, Part Number, and Item Number
to which your answer refers; and sign and date each sheet.
1.a

Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2.

5.b. Part Number

5.c. Item Number

5.d.

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A-Number (if any)

► A3.a. Page Number

3.d.

4.a. Page Number

4.d.

Form G-884 09/19/16

3.b. Part Number

3.c. Item Number

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

4.b. Part Number

4.c. Item Number

7.a. Page Number

7.d.

Page 6 of 6