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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
1.94 when I entered as a nonimmigrant member of the military, and I am filing this application for an initial Form 1-94. 4. Class of Admission at Last Entry into the United States E2 5. Place of Last Entry into the United States (City and State) NEW "PAsspoet ciplizpv-“ow. LDS ANhel-6,5 Form 1-102
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
it appears on Form 1-94, I-94W, or I-95. 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Class of Admission at Last Entry into the United States E2 5. Place of Last En into the United States City and State) Form 1-102 10/19/17 N Page 2 of 4 EFTA01731225 Part 4.
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
it appears on Form 1-94, I-94W, or I-95. 3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Class of Admission at Last Entry into the United States E2 5. Place of Last En into the United States City and State) Form 1-102 10/19/17 N Page 2 of 4 EFTA01684010 Part 4.
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.
I-94 when I entered as a nonimmigrant member of the military, and I am filing this application for an initial Form I-94. 4. Class of Admission at Last Entry into the United States E 5. Place of Last Entry into the United States (City and State) OartJ: :Pro- cessing Information . La. Are you filing th
Entities connected to both the Social Security Administration and Last Entry

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