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Supplement 8, Delaration of Law Enforcement Officer for Victim of Trafficking in Persons Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-914 OMBNo.1615-0099 Expires 1//31/2023 START HERE - Type or print in ink. This form should be completed by Federal, state. local,
3. Date of Binh (dd/mm/yyyy) 4. Gender or Sex 02/21/1985 K Male Female K Other 5. Alien Registration lo• A- Number (A-Number) (if any) 6. U.S. Social Security Number (SSN) (if any) Part 2. Agency Information I. 2. 3. 4. 5. 6. Name of Certifying Agency Federal Bureau of Investigations Name of Cenif
Supplement B, Delaration of Law Enforcement Officer for Victim of Trafficking in Persons Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-914 OMB No. 1615-0099 Expires 12/31/2023 START HERE - Type or print in ink. This form should be completed by Federal, state, local
ddle Name (if any) Date of Birth (ddirrun/yyyy) 4. Gender or Sex El Male El Female El Other Alien Registration Number (A-Number) (if any) P. A- U.S. Social Security Number (SSN) (if any) .r Part 2. Agency Information 1. Name of Certifying Agency Federal Bureau of Investigations 2. Name of Certifying Offici
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
(mrn/dcl/yyyy) ► Count of Birth 4.a. In Care Of Name 9. Country of Citizenship 4.b. Street Number and Name SLovit-11\- 4.c. Apt. 2 Ste. 10. U.S. Social Security Number (if an ) K Flr. 0 4.d. City or Town NEW t i ORIC Entry Information 4.e. State 4.f. ZIP Code 100toS 11. Date of Last Entry into the U
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
d. City or Town 6.e. State 0 6.f. ZIP Code Other Information 7. Date of Birth (mm/dd/yyyy) ► 8. Count of Birth 9. Count of 'fizen hi 10. U.S. Social Security Number if an City or Town NEAN otkg Entry Information State NY 4.1. ZIP Code 11. Date of Last Entry into the United States Is your current U
in Charge EFTA01653121 Supplement B, Delaration of Law Enforcement Officer for Victim of Trafficking in Persons Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-914 OMB No. 1615-0099 Expires 12/3112023 START HERE - Type or print in ink. This form should be completed by Federal, state, local
me (if any) 3. 5. 6. Date of Birth (dd/mm/yyyy) 4. Gender or Sex K Male ❑X Female K Other Alien Registration Number (A-Number) (if any) ► A- U.S. Social Security Number (SSN) (if any) Part 2. Agency Information I. Name of Certifying Agency Federal Bureau of Investigations 2. Namc of Certifying Official
Application for Naturalization Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form N-400 OMB No. 1615-0052 Expires 03/31/2019 For USCIS Use Only Date Stamp Receipt Action Block Remarks ► START HERE - Type or
would like to use in the spaces provided below. Family Name (Last Name) O Yes O No Given Name (First Name) Middle Name (if applicable) _J 5. U.S. Social Security Number (if applicable) 6. USCIS Online Account Number (if any) ► 7. Gender El Male I] Female 10. Country of Birth 8. Date of Birth (mm/ddi
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
Town 6.e. State O Flr. O 6.1. ZIP Code Other Information 7. Date of Birth (nmildcliyyyy) 10. 8. un of Birth 9. Coun of Citizenshi 10. U.S. Social Security Number if an Entry Information 11. Date of Last Entry into the United States (mni/dellyyyy) ► oi/a/e301° 12. Place of Last Entry into the Unite
Entities connected to both U.S. Citizenship and Immigration Services and U.S. Social Security

Jeffrey Epstein
PERSON
Department of Homeland Security
ORGANIZATIONFBI
ORGANIZATION
Homeland Security
ORGANIZATION
United States
LOCATION
Department of Justice
ORGANIZATION
Ghislaine Maxwell
PERSONLeon Black
PERSONNew York Field Office
LOCATION
Birth
PERSONU.S. Immigration and Customs Enforcement
ORGANIZATIONPreparer
ORGANIZATIONAlbany
LOCATIONFederal, State
ORGANIZATIONDivision/Office of Certifying
ORGANIZATIONDaytime Telephone Number
ORGANIZATIONDelaration of Law Enforcement
ORGANIZATIONthe Social Security Administration
ORGANIZATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATION