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    PRA San Antonio

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    omar hernandez
    The document is a request form for assistance from Congressman Henry Cuellar of Texas. It requests information about the nature of the request, any other officials contacted, and personal details like name, address, phone number, and whether there is a deadline. The requester must authorize the congressman's office to make inquiries on agencies to address the request.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PRA San Antonio

    Uploaded by

    omar hernandez
    31 views1 page
    The document is a request form for assistance from Congressman Henry Cuellar of Texas. It requests information about the nature of the request, any other officials contacted, and personal details like name, address, phone number, and whether there is a deadline. The requester must authorize the congressman's office to make inquiries on agencies to address the request.

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    Ojh

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    The document is a request form for assistance from Congressman Henry Cuellar of Texas. It requests information about the nature of the request, any other officials contacted, and personal details like name, address, phone number, and whether there is a deadline. The requester must authorize the congressman's office to make inquiries on agencies to address the request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views1 page

    PRA San Antonio

    Uploaded by

    omar hernandez
    The document is a request form for assistance from Congressman Henry Cuellar of Texas. It requests information about the nature of the request, any other officials contacted, and personal details like name, address, phone number, and whether there is a deadline. The requester must authorize the congressman's office to make inquiries on agencies to address the request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    CONGRESSMAN HENRY CUELLAR – TX 28

    In order to serve you, this form must be completed


    In full by the person requesting help or his/her power of attorney

    To: Congressman Henry Cuellar


    615 East Houston Street, Suite 563
    San Antonio, TX 78205
    Phone: (210) 271-2851
    Fax: (210) 277-6671

    Please briefly explain the nature of your request along with what actions you have taken:
    __________________________________________________________________________
    Text
    __________________________________________________________________________
    __________________________________________________________________________
    __________________________________________________________________________

    Have you contacted any other Congressional Office (House or Senate) with this issue? If
    “Yes”, please list Representative(s) or Senator(s):
    __________________________________________________________________________
    __________________________________________________________________________

    Please print the following information (if applicable):

    __________________________________ ____________________________________
    Name Social Security Number
    __________________________________ ____________________________________
    Mailing Address A File Number (USCIS)
    __________________________________ ____________________________________
    City, State, Zip Code VA Claim Number
    __________________________________ ____________________________________
    Home Phone Date of Birth
    __________________________________ ____________________________________
    Business Phone Fax
    __________________________________ ____________________________________
    Cellular Phone Email

    Are you facing a deadline? Yes_____ No_____ When?_____


    Are you currently being represented by an attorney regarding this matter? Yes____ No____
    If “Y”, please provide the attorney’s name and contact number:
    __________________________________________________________________________

    In accordance with the Privacy Act of 1974, I,_____________________________, hereby personally


    authorize Congressman Henry Cuellar and/or his staff, as designated by him, to make any and all
    inquiries with Federal, State, County, Municipal and other agencies as needed to address my
    request, but not limited to the issue described above.

    ________________________________________________ _____________
    Signature Date Staff Initials

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