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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
ature Interpreter's Mailing Address 3.a. Street and Name 3.b. K Apt. 3.c. City or 3.d. State 3.f. Province 3.g. Postal 3.h. Country Number K Ste. Town Preparer's 1.a. 1.b. 2. Preparer's Full Name Preparer's Family Name (Last Name) K Flr. Preparer's Given Name (First Name) 3.e. ZIP C
III Page 1 of 7 EFTA01699786 Part 2. Information About You (continued) Your U.S. Mailing Address 5.a. 5.b. Street Number and Name 5.e. Apt. K Ste. K Flr. 5.d. City or Town 5.e. State Naze) uor- 5.f. ZIP Code I 00105 6. Is your current mailing address the same as your physical address?
te and include his telephone and fax number A A EFTA00155344 Supplement B, U Nonimmigrant Status Certification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-918 OMB No. 1615-01 Expires 04/30/202 Remarks For 115C IS Use Only ► START HERE - Type or print in black or blue ink. Part 1.
Head of Certifying Agency 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 5.a. Street Number and Name 5.b. K Apt. K Ste. K FIr. 5.c. City or Town 5.d. State 5.f. Province 5.g. Postal Code 5.h. Country 4.f. ZIP Code Other Agency Information 6. Agency Type O
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;
84013 Part 2. Information About You (continued) Your U.S. Mailing Address 5.a. In Care Of Name (if any) 5.b. Street Number and Name 5.c. Apt. K Ste. 5.d. City or Town 5.e. State ■ 51 ZIP Code 6. Is your current mailing address the same as your h sical address? NOTE: If you answered "No" to
Entities connected to both U.S. Citizenship and Immigration Services and K Ste

Jeffrey Epstein
PERSON
Department of Homeland Security
ORGANIZATIONFBI
ORGANIZATION
Homeland Security
ORGANIZATION
United States
LOCATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONNew York Field Office
LOCATIONAlbany
LOCATIONFederal, State
ORGANIZATION
Birth
PERSONPreparer
ORGANIZATIONNational Crime Information Center
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONMonitoring Case
ORGANIZATIONMonitoring Group
ORGANIZATIONthe Social Security Administration
ORGANIZATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONContact Information, Certification
ORGANIZATION