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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
nder deportation proceedings? 0 Yes 0 No (if yes, where and when) City, State: 5. When did the Victim enter the United States? 6. Through which Port of Entry did the Victim enter the United States 7. How did the Victim enter the United States? Flight Part D: Specific Information Pertaining to the Victim.
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
r deportation proceedings? K Yes ❑X No (if yes, where and when) City, State: 5. When did the Victim enter the United States? Ma 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight Part D: Specific Information Perta
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
r deportation proceedings? K Yes ❑X No (if yes, where and when) City, State: 5. When did the Victim enter the United States? Ma 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight Part D: Specific Information Perta
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.
proceedings? 0 Yes Ej No (if yes, where and when) City, State: 5. When did the Victim enter the United States? 1st Entry 09/0145 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight oi3/40 5,1* -00,09;**000:00.111M01
Entities connected to both the Social Security Administration and Port of Entry

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