Form 3; instructions 5.

12/23/16. No previous editions accepted. You can find the edition date at the bottom of the page on the form and instructions.

Mail your request to:

USCIS Genealogy Program
P.O. Box 805925
Chicago, IL 60680-4120

$65. You may pay the fee with a money order, personal check, or cashier’s check.  When filing at a USCIS Lockbox facility, you may also pay by credit card using Form G-1450, Authorization for Credit Card Transactions. If you pay by check, you must make your check payable to the U.S. Department of Homeland Security. Please note that service centers are not able to process credit card payments. Use our Fee Calculator to help determine your fee.

Note on fees: If you are submitting this form from outside the United States, you may pay the fee with an international bank money order or foreign draft drawn in U.S. dollars and payable through a U.S. bank. Make all payments payable in U.S. currency to the U.S. Department of Homeland Security. If the file number provided does not match the immigrant named on this form, and there is no previous Genealogy Index Search case identification number provided, we will not refund any fee.

Please do not submit this checklist with your Form G-1041A. It is an optional tool to use as you prepare your form, but does not replace statutory, regulatory, and form instruction requirements. We recommend that you review these requirements before completing and submitting your form. Do not send original documents unless specifically requested in the form instructions or applicable regulations.

If you submit any documents (copies or original documents, if requested) in a foreign language, you must include a full English translation along with a certification from the translator verifying that the translation is complete and accurate, and that they are competent to translate from the foreign language to English.

Did you provide the following?

• Documentary proof of death if the person was less than 100 years old:
  • Death certificate (uncertified copy)
  • Printed obituaries, funeral programs, or photographs of gravestones
  • Bible, church, or other religious records
  • U.S. Social Security Death Index records (individual records only, not lists)
  • Records relating to the payment of death benefits
  • Other documents demonstrating the immigrant of the request is deceased