4
Shared Docs
4
Same-Page
4 / 4
Mentions
ther because I have not been notified that I am subject to backup withholding as a result of failure to report all interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Reven
Ia First Name Date of Birth (MAYDDNYYY) Gender: x Male i& Female Mother's Maiden Name (mothers last name before manage) (4-digits required) Middle Initial Suffix Phone Center ID BROOKLYN Home Phone Number NY 11207-1012 House # NS Street Name Street NS APT/ APT! City ST Zip Code EW Typ
ther because I have not been notified that I am subject to backup withholding as a result of failure to report all Interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Reven
ng Information L X Verification Issued By: NY Gender: Male x Female Me — Please tell us about yourself Noel Tova A Last Name First Name Middle Initial Suffix Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone (MM/D0NYYY) (mother's last name before marriage)
ther because I have not been notified that I am subject to backup withholding as a result of failure to report all Interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Reven
p: Employee of the CI X Verification Issued By: NY Amends Existing Information Gender: Male x Female Mc Nocl _Tina A Last Name First Name Middle Initial Suffix 3650 Date of Birth Social Security Number Mother's Maiden Name Phone Center ID Home Phone (WIt0CX'YYYY) (mothers lasl name before mar
ther because I have not been notified that I am subject to backup withholding as a result of failure to report all Interest or dividends, or because the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen (including a U.S. resident alien). The Internal Reven
d By: NY Date of Birth (MMOD/YYYY) Sopa can umber RAN Gender: x Male par Female Mother's Maiden Name (mothers last name before marriage) Middle Initial Suffix Phone Center ID (4-digits required) Number BROOKLYN NY 11207-1012 House # NS Street Name Street NS APT/ APT! City ST Zip
Entities connected to both the Internal Revenue Service and Middle Initial

Jeffrey Epstein
PERSON
Ghislaine Maxwell
PERSON
United States
LOCATION
George W. Bush
PERSONLeon Black
PERSONMaria Farmer
PERSONDarren Indyke
PERSON
Bradley Edwards
PERSON
NEW YORK NY
LOCATION
Alan Dershowitz
PERSON
Scarlett Johansson
PERSONJane Doe
PERSON
Joi Ito
PERSON
Paul Cassell
PERSON
Eric Holder
PERSON
Kenneth Marra
PERSONJack Goldberger
PERSONDoug Band
PERSON
Condoleezza Rice
PERSON
Alfredo Rodriguez
PERSON