OMB# 1125-0017|Exp. 02/28/2027

EOIR-59: Certification and Release of Records

U.S. Department of Justice — Executive Office for Immigration Review

Complete this form to authorize the release of your EOIR records to an attorney, accredited representative, or other third party.

Alien Registration Number(s) (A-numbers)

Current Legal Name (Last, First, Middle) *

Other Names By Which You Have Been Known Since Birth

Current Address

Street Number and Name

Apartment/Unit Number (if any)

City and State or Province

Country

Zip Code (if any)

Telephone Number

Previous Address (if applicable)

Note: If you are a noncitizen and your address has changed, please complete the EOIR-33.

Street Number and Name

Apartment/Unit Number (if any)

City and State or Province

Country

Zip Code (if any)

Telephone Number

Date of Birth (mm/dd/yyyy)

Country of Nationality or Citizenship

Place of Birth

Records Release Option

Release all of my records

Only release the following records:

Recipient's Full Name (Last, Middle, First) *

Recipient's Organization (if applicable)

Recipient's Mailing Address

In Care of Name (if any)

Street Number and Name

Apartment/Unit Number (if any)

City and State or Province

Country

Zip Code (if any)

Telephone Number

Recipient's Email Address *

Recipient's Relationship to Subject of Record

Attorney or legal representative

Proceed to Part D.

Parent or guardian

If signing on behalf of Subject of Record, you must complete Part C.

Other (please specify)

Recipient's EOIR-ID Number (if any)

Signature of Noncitizen, Subject of Record, or Parent or Guardian of Subject of Record

By my signature below, unless otherwise specified above, I consent to EOIR releasing any and all information relating to me to the above-named Recipient. This consent will allow the Recipient to receive and/or examine potentially sensitive information and documents. If filing this request on my own behalf, I also consent to pay all costs incurred for search, duplication, and review of documents up to $25.

I further declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person named in Part A above, and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. § 1001 by a fine of not more than $10,000 or by imprisonment of not more than five years or both.

Signature *

Date

Upload supporting documents such as a copy of your government-issued ID, proof of relationship (for Part C), or any other relevant documents.

or drag and drop files here

Maximum file size: 10MB

Or email documents to[email protected]

Form EOIR-59 | Rev. Aug. 2023 | Exp. 02/28/2027

Someone Detained by ICE?

EOIR-59: Certification and Release of Records

Current Address

Previous Address (if applicable)

Recipient's Mailing Address

Signature of Noncitizen, Subject of Record, or Parent or Guardian of Subject of Record