3 4 5 9  Lawrenceville - Suwanee  Rd., Suite A,  Suwanee ,  Georgia

Tel: (770) 271-5244 ● Toll Free:  (888) 768-7252 ● Fax: (770) 271-5604 ● Cornel@PotraLawFirm.com ● www.potralawfirm.com

Attorneys:  Cornel Potra – Admitted: Georgia & Washington  ●  Kristina F Potra – Admitted: Georgia

This questionnaire is for the exclusive use of Potra Law Firm.  Please answer all the questions.  Do not leave any questions unanswered.  If you do not have an answer to a question, please insert “N/A”.  It is your responsibility to provide true and accurate information, as well as the evidentiary documents requested. 

This Document Is For The Attorney’s Office Use Only

 

  

QUESTIONNAIRE FOR FREEDOM OF INFORMATION/PRIVACY ACT REQUEST

FOIA

 

 

 

 

Personal Information

1. Full Name

a. Family name

 b. First name

c. Middle name

 
 

2. Other name(s) used:

a. Maiden name

b. Name(s) used from prior marriage(s)

 

 

3. Give your name at the time of entry into the U.S.:

 

a. Family name

 b. First name

c. Middle name

 
 

4. Number of I-94 card          

5. Alien Registration Number  (A#, if any)

6. Country of birth

7. Date of birth month/day/year

8. Place of birth City/State (Province)

 

 

9. Give the names of other family members that may appear on requested record:

 

10. Information about your father

 

a. Family Name

b. First Name

c. Middle Name

 

11. Information about your mother

 

a. Maiden Name

b. First Name

c. Middle Name

 

 

 

12.Country of origin:

 

Information about your entry in the U.S.

 

13. Port of entry City/State

14. Date of entry month/day/year

15. Manner of entry

16. Name of the company you traveled with (carrier)

 

 

If it applies, please give the following:

 

17. Social Security Number

 

18. Name on the Naturalization Certificate

 a. Family name

b. First name

c. Middle name

 

19. The number for Naturalization Certificate

20. The date of Naturalization month/day/year

21. The address at time of Naturalization  

 

a. Street number

b. City

c. State

d. Zip Code

22.Location of Naturalization (City/State)

 

  

 
 

Documents needed for BCIS purposes:

  

*

Copy of passport (including the page with visa for U.S.

 

*

Copy of I-94 card

*

Copy of Driver License

*

Copy of Social Security Card

*

Copy of Green Card

*

Copy of any court issued documents

*

Copy of any BCIS issued documents

NOTE: THIS DOCUMENT IS THE PRODUCT OF POTRA LAW FIRM. THE USE OF THIS QUESTIONNAIRE BY OTHER INDIVIDUALS OR LAW FIRMS IN ASSISTING OTHERS WITH THE COMPLETION OF DOCUMENTS, OR FOR ANY OTHER PURPOSES, IS STRICTLY PROHIBITED.   POTRA LAW FIRM MAINTAINS ITS COPYRIGHTS OVER THE TRANSLATION OF THIS DOCUMENT.  PERMISSION TO USE THIS DOCUMENT MAY BE OBTAINED ONLY FROM POTRA LAW FIRM.  COPYRIGHT © January 17, 2007.