Response

Petitioner/Applicant Information

Prefix

First Name

Last Name

Address Line 1

City

State

Zip

Home Phone

Cell Phone

Work Phone

Date of Birth

Alien Number (if any)

Country of Birth:

Beneficiary Information

Beneficiary's Name:

Beneficiary's Country of Birth:

Beneficiary's Alien Number (if any):

Beneficiary's Date of Birth:

USCIS Receipt Number or other Tracking Number (**NO Social Security numbers**):

Date of Filing

If Other (Write In)

Brief Description of the issue:

Have you spoken with Senator Luján or his staff regarding this concern? If so, who?

In addition to Senator Lujan's Office, please indicate any other congressional office or state office you have contacted:

What can our office assist you with?

I certify, under penalty of perjury, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; and 3) all of this information is complete, true, and correct.

I, authorize USCIS to release information contained in my USCIS records as relevant to checking my case status, and to the extent permitted by law, to Senator/Representative and the Member's staff.I, authorize USCIS to release information contained in my USCIS records as relevant to checking my case status, and to the extent permitted by law, to Senator/Representative and the Member's staff.

Written Name

Today's Date

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