3
Shared Docs
3
Same-Page
3 / 3
Mentions
er information section. Mail the form to the address on the reverse side of this form along with the filing fee. The fee is payable by check. VISA, MasterCard or American Express. Checks must be payable to the "Department of State. Credit Card/Debit Card Authorization forms can be found on our • .dos.ny.
PERIOD FEE 1379614 08/2003 89.00 If there are no changes to the information printed in Part B, sign Part C and return with payment payable to the Dept. of State Alecto:090200 a 71/4/0 mAn MARES ItEtOm TIC LINE (yell( MOST SIGN ON PFVERSPV 005.1175 437/SSI SDNY_GM_D0 173797 EFTA_00 195452 EFTA01305697
er information section. Mail the form to the address on the reverse side of this form along with the filing fee. The fee is payable by check, VISA. MasterCard or American Express. Checks must be payable to the "Department of State". Credit Card/Debit Card Authorization forms can be found on our website at
PERIOD FEE 1379614 08/2003 89.00 If there are no changes to the information printed in Part B, sign Part C and return with payment payable to the Dept. of State Alecto:090200 a 71/4/0 mAn MARES ItEtOm TIC LINE (yell( MOST SIGN ON PFVERSPV 005.1175 437/SSI SDNY_GM_D0 173335 EFTA_00 194990 EFTA01305235
er information section. Mail the form to the address on the reverse side of this form along with the filing fee. The fee is payable by check, VISA, MasterCard or American Express. Checks must be payable to the 'Department of State'. Credit Card/Debit Card Authorization forms can be found on our website at
PERIOD FEE 1379614 08/2003 S9.00 If there are no changes to the information printed in Part B, sign Part C and return with payment payable to the Dept. of State 6 40:090200 ovrio &ISO MIRZS snb humagsg 117S WV BM EFTA00073339 IMPORTANT NOTICE k New York Corporation Which is no longer conducting busin
Entities connected to both MasterCard and the Dept. of State

Jeffrey Epstein
PERSON
American Express
ORGANIZATION
George W. Bush
PERSONDarren Indyke
PERSON
Ghislaine Maxwell
PERSON
NEW YORK NY
LOCATION
Prince Andrew
PERSON
New York City
LOCATION
Les Wexner
PERSONthe Southern District
LOCATION
Columbus
LOCATION
New York
LOCATION
New York State
LOCATIONFBI
ORGANIZATIONthe State of New York
LOCATION
U.S. Virgin Islands
LOCATIONthe Department of State's
ORGANIZATIONThe Certificate of Dissolution
ORGANIZATIONthe City of Albany
LOCATIONSchwartz
PERSON