the Social Security Administration
ORGANIZATIONthe NYS Division of Criminal Justice Services
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. 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
Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Tel:l-800-262-DCJS Michael C.Green, Executive Deputy Commissioner of the NYS Division of Criminal Justice Services *Federal NCIC * WARNING: Release of any NCIC information to unauthorized individuals or agencies,including the subject of the data, is prohibited.
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
Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Te1:1-800-262-DCJS Michael C.Green, Executive Deputy Commissioner of the NYS Division of Criminal Justice Services *Federal NCIC * WARNING: Release of any NCIC information to unauthorized individuals or agencies,including the subject of the data, is prohibited.
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
of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Tell-800-262-DCJS xecutive Deputy Commissioner of the NYS Division of Criminal Justice Services *Federal NCIC * WARNING: Release of any NCIC information to unauthorized individuals or agencies,including the subject of the data, is prohibited.
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
of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Tell-800-262-DCJS xecutive Deputy Commissioner of the NYS Division of Criminal Justice Services *Federal NCIC * WARNING: Release of any NCIC information to unauthorized individuals or agencies,including the subject of the data, is prohibited.
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.
rvices Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. 'Fel: I -800-262-DCJS Michael C.Green, Executive Deputy Commissioner of the NYS Division of Criminal Justice Services *Federal NCIC * WARNING: Release of any NCIC information to unauthorized individuals or agencies,including the subject of the data, is prohibited.
Entities connected to both the Social Security Administration and the NYS Division of Criminal Justice Services
Albany
LOCATION
Michael C.Green
PERSONNew York State Division of Criminal Justice Services
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATION
Jeffrey Epstein
PERSON
United States
LOCATION
New York City
LOCATION
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATION
Department of Justice
ORGANIZATIONNew York Field Office
LOCATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONContact Information, Certification
ORGANIZATIONMonitoring Case
ORGANIZATIONFBI
ORGANIZATIONMonitoring Group
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATION