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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
If the Victim resides outside the geographic area of the lead Case Agent, a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Print Name and Title) (Date) (Monitoring Case Agent's Signature) (Date) (Print Name and Title) Request for Continued P
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
he Victim resides outside the geographic area of the lead Case Agent, a monitoring agent must be designated in the appropriate jurisdiction. —1 I (Monitoring Group Supervisor's Signature) (Date) (Print Name and Title) (Monitoring Case Agent's Signature) (Date) (Print Name and Title) Request for Continued P
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
If the Victim resides outside the geographic area of the lead Case Agent, a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Print Name and Title) (Monitoring Case Agent's Signature) (Print Name and Title) (Date) Request for Continued Presence
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
If the Victim resides outside the geographic area of the lead Case Agent, a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Date) (Print Name and Title) (Monitoring Case Agent's Signature) (Print Name and Title) Request for Continued Presence
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.
if the Victim resides outside the geographic area of the lead Case Agent, a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Date) (Print Name and Title) (Monitoring Case Agent's Signature) (Date) (PrintRame and Title) Request for Continued Pr
Entities connected to both the Social Security Administration and Monitoring Group

Jeffrey Epstein
PERSON
United States
LOCATION
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATIONAlbany
LOCATIONMonitoring Case
ORGANIZATIONNew York Field Office
LOCATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONContact Information, Certification
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONPreparer
ORGANIZATIONFederal, State
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONNational Crime Information Center
ORGANIZATIONICE-011 Immigration and Enforcement Operational Records
ORGANIZATIONFBI
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATION