Epstein Secrets

. 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

or print in black ink Part 1. Information About You U.S. Physical Address To Be Completed by an Attorney or Accredited Representative, if any. K Select this box if Form O-28 is attached to represent the applicant. Attorney State License Number I. Alien Registration Number (A-Number) 6.a. In Ca

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

amp Action Block Valid From K Authorization/Extension Valid Through Alien Registration Number A- , Remarks To be completed by an attorney or K Select this box if Form G-28 Attorney or Accredited Representative Board of Immigration Appeals (BIA)- accredited representative (if any). is attached.

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.

U.S. physical address in Item Numbers 6.a. - 6.1. 1 1 La. In Care Of Name To Be Completed by an Attorney or Aerredited Representative, if any. K Select this box if Form G-28 is attached to represent the applicant. Attorney State License Number Lb. Street Nut and Name 6.c. Apt. 0 Ste. 0 FIr.