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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.
R ISSUING OFFICE ONLY O PPT BK CORO PPT BK SM O PPT CD CM O PPT CD Sal 0 Marriage Certificate Date of MarriagelPlace Issued: o Court Order Date Filedtoun: From To' O Other 0 Attached: 1111111 11111 Date !)111 SS' gft 111 11 For Issuing Office Only —0 , Bk Fee _ Cd Fee EF Postage
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.
UING OFFICE ONLY El PPT BK CM 0 PPT BK SM 0 PPT CD C/R 0 PPT CD Sal O Marriage Certificate Date of MarriagelPlace Issued: o Court Order Date Filedtoun: From To: El Other: O Attached: 1111111 11111 Dale 111III 111{111,111 111 11 For Issuing Office Only —0 , Bk Fee Cd Fee. EF Po
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.
ING OFFICE ONLY EI PPT BK CM 0 PPT BK SIR 0 PPT CD C/R O PPT CD SIR O Marriage Certificate Date of Marriage+Place Issued: O Court Order Date Filedtoun: From To' 0 Other. K Attached: For Issuing Office Only —0 , Bk Fee Cd Fee. EF Postage Other 1111111 11111 Date DS-82 08-2013
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.
ISSUING OFFICE ONLY K PPT BK CM 0 PPT BK SIR K PPT CD C/R O PPT CD SfR O Marriage CerMicate Date of MarriagelPiace Issued: O Court Order Date Filedtoun: From To: O Other O Attached: 1111111 11111 Date IIUIIII~IIIHI 111I111 111 11 For Issuing Office Only —0 , Bk Fee Cd Fee. EF Pos
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.
ISSUING OFFICE ONLY 0 PPT BK CM 0 PP7 BK SAR K PP7 CD C/R O PP7 CD SIR O Marriage Certificate Date of MerriagelPiece Issued: ID Court Order Date Filedtoun: From To' 0 Other K Attached: 1111111 11111 Date 111,111 DSS2 3(s_ 111 11 For Issuing Office Only Bk Fee _ Cd Fee EF Postage O
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.
SUING OFFICE ONLY K PPT BK CORO PPT BK SIR K PPT CD C/R 0 PPT CD SfR O Marriage Certificate Date of MarriagelPiace Issued: O Court Order Date Filedtoun: From To' 0 Other. K Attached: 1111111 11 1 11 Date 111101111111111 1111111 111 11 For Issuing Office Only —to 8k Fee_ Cd Fee. E
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.
UING OFFICE ONLY El PPT BK CORO PPT BK SIR 0 PPT CD C/R 0 PPT CD SfR O Marriage Certificate Date of MarriagelPiace Issued: O Cowl Order Date Filedtoun: From Toe 0 Other O Attached: 1111111 11111 Date 111101111111111 1111111 111 11 For Issuing Office Only —le Bk Fee Cd Fee EF Po
Entities connected to both U.S. Embassy and Filedtoun

Jeffrey Epstein
PERSONJane Doe
PERSONLeon Black
PERSONDarren Indyke
PERSON
Philadelphia
LOCATIONU.S. PASSPORT RENEWAL APPLICATION
ORGANIZATION
Birth
PERSON
the Internal Revenue Service
ORGANIZATIONTHE U.S. PASSPORT CARD
ORGANIZATIONPassport Services
ORGANIZATIONOVFRNIGHT
ORGANIZATIONNational Passport Processing Center
ORGANIZATIONPassoon Services
ORGANIZATIONSTATE DEPARTMENT FACILITY
ORGANIZATIONthe Federal Claims Collection Standards
ORGANIZATIONSystem of Records
ORGANIZATIONOverseas Citizen Services Records
ORGANIZATIONPassport Records
ORGANIZATIONOffice of Program Management and Operational Support
ORGANIZATION
BERMUDA
ORGANIZATION