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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
ent of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-765 OMB No. 1615-0040 Expires 05/31/2020 For USCIS Use Only El Authorization/Extension Valid From Fee Stamp Action Block 0 Authorization/Extension K Valid Through Allen Registration Number A-L i I Remarks To be completed by an
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
ent of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-765 OMB No. 1615-0040 Expires 05/31/2020 For USCIS Use Only El Authorization/Extension Valid From Fee Stamp Action Block 0 Authorization/Extension K Valid Through Allen Registration Number A-L i I Remarks To be completed by an
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.
thorization Pepartineat-Of SOmetanctSecurity U.$: Citizenship andimmigratibn Services. TiRaS . Form T-7.65 OMB Ho. 1615.0040 Expires 05/31/2020 El Authorization/Extension ValidTrom . . teeStinlit Adtion block `For WSCISI Vat I 0 Authorization/EXtention Valid:Through 0 1'4 i Alien Registration Number A- I •
Entities connected to both the Social Security Administration and El Authorization/Extension

Jeffrey Epstein
PERSON
United States
LOCATION
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONFBI
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
ORGANIZATIONNational Crime Information Center
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATIONContact Information, Certification
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATION