3
Shared Docs
3
Same-Page
3 / 3
Mentions
. 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
FEB6E-AL PIA2ft Contact Information K Flr. 4. Interpreter's Daytime Telephone Number 3.c. City or Town NEW YORK 5. 3.d. State 3.e. ZIP Code Interpreter's Mobile Telephone Number (if any) N V Idris 3.f. Province 6. Interpreter's Email Address (if any) 3.g. Postal Code 3.h. Country Interpreter's Certification I certify
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
E-f\L PLAZIN Contact Information O Flr. 4. Interpreter's Daytime Telephone Number NEW YOIZW--- 3.c. City or Town 5. 3.d. State 3.e. ZIP Code Interpreter's Mobile Telephone Number (if any) NV 10276 3.1. Province 6. Interpreters Email Address (if any) 3.g. Postal Code 3.h. Country Interpreter's Certification I certify,
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.
et Number and Name K Apt. K Ste. Contact Information K Flr. 4. Interpreter's Daytime Telephone Number 3.c. City or Town 5. 3.d. State 3.e. Interpreter's Mobile Telephone Number (if any) ZIP Code 3.f. Province 6. Interpreter's Email Address (if any) 3.g. Postal Code 3.h. Country Interpreter's Certification I certify,
Entities connected to both the Social Security Administration and Interpreter's Mobile Telephone Number

Jeffrey Epstein
PERSON
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONNational Crime Information Center
ORGANIZATIONAlbany
LOCATIONNew York Field Office
LOCATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATIONContact Information, Certification
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATIONBirth (mo.
LOCATIONHomeland Security Investigations
ORGANIZATION