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Fillable Form G-1041A

Form G-1041A is a request form for obtaining certain historical records from the United States Citizenship and Immigration Services (USCIS).

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What is Form G-1041A?

Form G-1041A, officially titled Genealogy Records Request is a form issued by the United States Citizenship and Immigration Services (USCIS) that allows people to file a request for the official historical records of their heritage found in the records of the USCIS. This form is often used by researchers for obtaining a copy of a specific record in the USCIS database.

However, the G-1041A Form requires that you have the official USCIS File Number of the record you are requesting, in order to properly complete this form. To acquire the File Number, you must file Form G-1041, Genealogy Index Search Request.

Acquiring the documents that are requested in the G-1041A Form has a fee of $65 each. Copies can be of microfilm or printed hardcopies. They cost the same.

If you are filing your G-1041A Form to obtain a record belonging to an immigrant whose birthday was less than 100 years from the current date, you must attach a document that will validate their death. Do not send original copies of these documents as the USCIS will not return them. Viable documents include the following:

  • Death Certificate (uncertified copy).
  • Printed Obituaries.
  • Religious Records.
  • US Social Security Death Index records.
  • Any other documents that will validate the immigrant’s deceased state.

When should I not use the G-1041A Form?

The USCIS Form G-1041A should not be used to acquire the following documents, as there are different departments that should handle them and different forms to file:

  • Records of Naturalization from dates before the 27th of September 1906. The National Archives and Records Administration (NARA) Record Group 21 should be contacted instead.
  • Sea, land, and air manifests on dates before December 1982. If you are searching for these lists, contact NARA.
  • Requesting the return of the original copy of a document. For this request, file Form G-884, Request for Return of Original Documents.
  • Certified copies of the historical records. The USCIS can only provide photocopies.
  • Deportation Records.
  • Certification of Nonexistence of a Naturalization Record. Requests of this nature must be submitted to the USCIS Records Operations Branch.

How to fill out Form G-1041A?

People who are interested in securing a copy of some documents from the USCIS can find a PDF version of the G-1041A Form for download at the USCIS official government website. Additionally, you can also fill out the form online at PDFRun.

When filling out the form, the USCIS explicitly mentioned filling out the G-1041A Form in black ink. It is advised that you follow this. Furthermore, if the information requested is not applicable, input “N/A”. Do not leave it blank.

Part 1 - Information About You

1 - Requestor’s Full Name

1.a. Family Name

Indicate your legal last name.

1.b. Given Name

Indicate your legal first name.

1.c. Middle Name

Indicate your legal middle name.

2 - Requestor’s Mailing Address

2.a. In Care-of Name (if any)

If you plan on having the requested document sent to a care-of (C\O). Indicate the complete and legal name of the Care-of.

2.b. Street Number and Name

Enter your Street Number and Street Name in full. Do not abbreviate.

2.c. Apartment, Suite, Floor

First, indicate if you are living in an apartment, suite, or floor by checking the applicable boxes. Then, indicate the apartment, suite, or floor number based on how they appear (Apartment, Suite, then Floor).

2.d. City or Town

Input the city or town of your current address.

2.e. State

Choose the state of your current residence.

2.f. ZIP Code

Indicate the ZIP code of your current address.

2.g. Province

Input the province of your current residence.

2.h. Postal Code

Indicate your postal code.

2.i. Country

Indicate the country of your current residence.

Requestor’s Contact Information

3. Requestor’s Daytime Telephone Number

Input the telephone number you use during business hours.

4. Requestor’s Mobile Phone Number

Input your current and serviceable mobile phone number.

5. Requestor’s Email Address

Input your current professional email address.

Requestor’s Certification

6.a. Requestor’s Signature

Read the clause above the line. Affix your signature here to consent to the payment required to file this form ($65).

6.b. Date of Signature

Indicate the date of signing (mm/dd/yyyy).

Part 2 - Information Needed to Release a Historical Record

Item 1.a

Indicate if the information of the record that is being requested that will be written below is from a Form G-1041, Genealogy Index Search Request. Check “Yes” if it is. Otherwise, check “No”.

Item 1.b.

If you answered “Yes” in Item 1.a, input the Genealogy Search index Case number of the file.

Full Name of Immigrant

Indicate the full name of the immigrant.

2.a. Family Name

Input the last name of the immigrant.

2.b. Given Name

Indicate the first name of the immigrant.

2.c. Middle Name

Enter the Middle name of the immigrant.

Other Names Used by the Immigrant

If the immigrant whose records you are requesting has undergone a change of name or is registered with different names on other records. You must indicate it here. If they had more than one alternative name, input the other names on the spaces provided in Part 4.

3.a. Family Name

Indicate the alternative last name the immigrant might have used.

3.b. Given Name

Indicate the alternative first name the immigrant might have used.

3.c. Middle Name

Indicate the alternative middle name that the immigrant might have used.

Other Information for the Immigrant

These include address and date of birth.

4.a. Date of Birth

Indicate the immigrant’s date of birth in mm/dd/yyyy format.

Item 4.b.

Indicate if the date entered in Item 4.a, is the actual date of birth or just an estimate. Check the appropriate box.

Place of Birth

If any information is unknown, indicate so by inputting “N/A” instead of leaving the space blank.

5.a. Town or Village

Indicate the town or village where the immigrant in question was born.

5.b. Province

Indicate the province of birth of the immigrant in question.

5.c. Country

Indicate the country of birth of the immigrant in question.

Part 3 - Identification of Requested Record

In this part, you must provide the information necessary in order to find your desired document. Only fill out the section of your requested form.

Naturalization Certificate File (1906 - 1956)

1.a. Certificate Number

Input the certificate number of the requested record. This is a 7-digit code preceded by the letter “C” (e.g. C-1234567).

1.b. Date of Naturalization

Indicate the exact date that is recorded in the requested file.

1.c. Court

Indicate the court that legalized the naturalization of the immigrant.

1.d. City

Indicate the city where the immigrant was naturalized.

1.e. County

Indicate the county wherein the immigrant was naturalized.

1.f. Fee

Indicate what kind of copy you are requesting. If you are requesting a microfilm copy, then check the box beside “$65 (Microfilm)”. If you are requesting a hard copy, check the box besides “$65 (Hard Copy). If you are requesting both. Check both boxes.

Each copy requested costs $65 EACH.

Non-Standard C-Files

These are for files that are prefixed by B, D, OM, OS, A, AA, OL.

2.a. Number as Shown on Certificate

Indicate the number that is assigned to the certificate in question. This is a 7-digit code preceded by one of the letters mentioned above.

2.b. Date of Issuance

Input the date that the certificate was issued.

Alien Registration Record

Coded as AR-2 (1940-1944)

3.a. Alien Registration Number

Input the Alien Registration Number that is written on the record. This is a 7-digit code that is prefixed by “A” or “AR”.

3.b. Fee

If you are requesting a hardcopy of this specific record, check the box to confirm that you will be paying the price of $65 for copying the file.

A-File numbered below 8 Million

These are for A-Files with file numbers that are 7999999 and below.

4.a. A- File Number

Indicate the file number of the record.

4.b. Fee

Check the box to confirm that you are willing to pay $65 to obtain a hardcopy of the requested record.

Visa File

These are for records of Visa Files from 1924 to 1944.

5.a. Visa Number

Enter the Visa Number in the requested file.

5.b. Date of Entry

Input the Date of Entry within the requested file. That is the date that indicates the immigrant’s entry into the United States.

5.c. Port of Entry

Indicate the location indicated on the Visa File where the immigrant had entered the United States.

5.d. Ship

If the immigrant had come into the United States by sea, input the name of the ship that delivered them to the US.

5.e. Fee

Confirm that you are willing to pay $65 to acquire a hardcopy of this file by checking the box.

Registry File

6.a. Registry File Number

Input the file number of the requested record.

6.b. Fee

Check the box if you are requesting this form and will pay the $65 required to obtain the document.

Total Fees Due/Attached

Input the sum total of all the fees you will have to pay if you are requesting more than one form.

Part 4 - Additional Information

If you need extra space to provide information in any of the previous parts of the form, fill them out here. If you require more space than what is provided, you can make copies of page 3 of the form and attach it to the form as well.

1.a. Family Name

Indicate your complete, legal last name.

1.b. Given Name

Input your complete, legal given name.

1.c. Middle Name

Enter your complete, legal middle name.

For the following spaces, the formats and instructions are the same. However, each answer should be separate.

#.a. Page Number

Indicate the page wherein the item is found.

#.b. Part Number

Indicate on what part the item is found.

#.c. Item Number

Indicate the item number that you wish to answer.

Item #.d.

This is where you will input your answers. For items with subitems, you may input the answers for the subitems here as well and indicate the subitem letter (e.g. 2.a.; 2.b.; 2.c.).


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