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id) passport be lost or stolen, he will report the circumstances immediately to the Passport Office in Washington, DC, or, if abroad, to the nearest U.S. Embassy or Consulate. Thank you for your assistance with this matter. Sincerely, Darren K. K. Indyke General Counsel to Southern Trust Company, Inc.
inse•00,40^0/`••PMt — - 1. Name Last EPSTEIN JEFFREY 2. Date of Birth (ratraldggyy) 3. Sex 4. Place of Birth (City .5 State If In the U.S., or City 8 Country as It is prasentty known.) 0 1 2 0 1 9 5 3 X 5. Social Security Number 6. Email Address (e.g my emaq.8dornstn.com) 7. Primary Contact Phone Nu
itizens residing abroad CANNOT submit this form to the domestic address listed on the Instruction Page 2. Such applicants should contact the nearest U.S. Embassy or Consulate for procedures to be followed when applying overseas. WARNING: False statements made knowingly and willfully in passport applications.
3 5. Social Security Number 3. Sox IA F X Middle ED Ho DIM DOTS Code. End. # Exp. EDWARD 4. Place of Birth (City & State if in the U.S.. or City 8 Country as it is presently known.) NEW YORK, NY 6. Email Address 'op.. my [email protected]) 7. Primary Contact Phone Number 8. Mailln Address: Line 1: St
itizens residing abroad CANNOT submit this form to the domestic address listed on the Instruction Page 2. Such applicants should contact the nearest U.S. Embassy or Consulate for procedures to be followed when applying overseas. WARNING: False statements made knowingly and willfully in passport applications.
Social Security Number 3. Sex PA F x Middle DO Ljo r: DP DOTS Code. End. g Exp. EDWARD 4. Place of Birth (City & State if in the U.S.. or City 8 Country as it is presently known.) NEW YORK, NY 6. Email Address (e.g.. my [email protected]) 7. Primary Contact Phone Number 8. Mailing Address: Line I:
Entities connected to both U.S. Embassy and City 8 Country

Jeffrey Epstein
PERSONJane Doe
PERSONLeon Black
PERSONDarren Indyke
PERSON
Birth
PERSON
Philadelphia
LOCATIONU.S. PASSPORT RENEWAL APPLICATION
ORGANIZATIONPassport Records
ORGANIZATIONOverseas Citizen Services Records
ORGANIZATIONNational Passport Processing Center
ORGANIZATION
the Internal Revenue Service
ORGANIZATIONSTATE DEPARTMENT FACILITY
ORGANIZATIONthe Federal Claims Collection Standards
ORGANIZATIONTHE U.S. PASSPORT CARD
ORGANIZATION
BERMUDA
ORGANIZATIONA U.S. PASSPORT ISSUED
ORGANIZATIONTHE TRADITIONAL PASSPORT BOOK
ORGANIZATIONINTERNATIONAL AIR TRAVEL
ORGANIZATIONPassport Services
ORGANIZATIONOVFRNIGHT
ORGANIZATION