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11) Page 2 of 4 EFTA00173133 / Supervisory Special Agent 6. Is employment authorization requested? N Yes 0 No (If yes, please attach completed U.S. Citizenship and Immigration Services Forms 1-765, Application for Employment Authorization, and 1-102, Application for Replacement/Initia! Nonimmigrant Arrival/Departure Document) Note
. Marital Status 18.a. Country Single O Married O Divorced O Widowcd LovAiz. I 12. Have you previously filed Form 1-765? OYes ENo 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? @Yes O No NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. I
SENSITIVE ICE Form 73-031 (4/11) Page 2 of 4 EFTA00173743 6. Is employment authorization requested? Yes n No (II yes, please attach completed U.S. Citizenship and Immigration Services Forms 1-765, Application for Employment Authorization, and 1-102. Application for Replacement/Initial Nonimmigrant Arrival/Departure Document.) Not
l Status gs) Single 0 Married 0 Divorced K Widowed 18.a. Country 12. Have you previously filed Form I-765? 18.b. Country Oyes JNo 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? @Yes 0 No NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. I
SITIVE ICE Form 73-031 (4/11) Page 2 of 4 EFTA01684005 6. Is employment authorization requested? El Yes ID No (If yes, please attach completed U.S. Citizenship and Immigration Services Forms 1-765, Application for Employment Authorization, and 1-102. Application for Replacement/Initial Nonimmigrant ArriveDeparture Document.) Note;
your father's birth name. 16.a. Family Name (Last Name) 16.b. Given Name (First Name) Mother's Name Provide your mothers birth name. 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? 0 NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. If you ans
ENFORCEMENT SENSITIVE EFTA01699762 Application for Replacement/Initial Nonimmigrant Arrival-Departure Document Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-102 OMB No. 1615-0079 Expires 10/31/2019 For. i WOO Receipt Action Block UJe. : i I :Otifr• ! New I-94 Number I . Remarks
arital Status 18.a. Coun Eraingle K Married K Divorced K Widowed 12. Have you previously filed Form I-765? 18.b. Country ❑Yes E'No 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? ErYes K No NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14.
Entities connected to both U.S. Citizenship and Immigration Services and the Social Security Administration

Jeffrey Epstein
PERSON
United States
LOCATION
Department of Homeland Security
ORGANIZATIONFBI
ORGANIZATION
Department of Justice
ORGANIZATION
Homeland Security
ORGANIZATION
Prince Andrew
PERSON
Virginia Giuffre
PERSON
Kansas
LOCATION
Ghislaine Maxwell
PERSON
Donald Trump
PERSONLeon Black
PERSON
Cincinnati
LOCATION
Wisconsin
LOCATION
Colorado
LOCATION
Capitol
ORGANIZATION
Alfredo Rodriguez
PERSON
Michigan
LOCATIONAlbany
LOCATION
Oregon
LOCATION