Epstein Secrets

st Name) Given Name (First Name) Full Middle Name (/lappheable) 2. Date of Birth (Month/Day/Year) and Name 3. Date of Mamap (Month/Day/Year) 4. Spouse's Social Security Number / 5. Nome Address - Street Number Apartment Number City State ZIP Code 1 SDNY GM 00000722 runs N.4007Rev—OX3 I/01)N

ag Advance Parole Irf-Mulhple Advance Parole Validity to (1....< n 7, I C ig If Reentry Permit or Refugee Travel Document ID Mail to Address in Pan 2 O Marl to American Consulate O Marl to INS overseas office AT Remarks: (3 Document Hand Deivered On By Action Block 1*--) di i7 ( ../ To

ormation. 2017 Submission Identification Number (SID) Taxpayer's name ANASTASIYA SIROOCHENKO Spouses name Social security number ***4 "4-9816 Spouse's social security number IPartI Tax Return Information - Tax Year Ending December 31,2017 (whole dollars only) 1 Adjusted gross income (Form 1040,

00 00 .00 .00 B - NYS allocated amount .00 .00 .00 .00 .00 .00 .00 6 Total (add column A lines 5a through 5g) 7 Total of Schedule A, Pan 2, column A amounts from additional Form(s) 1.225, If any 8 Add lines 6 and 7 9 Total additions (add lines 4 and 8; see instructions) 225001171019

d Person means the Basic Cardmember, each Additional Cardmember, and each of these Cardmember's spouses or Domestic Partners and dependent children. Spouse includes the person to whom you are married, including your same-sex partner in your marriage that was legally performed in another jurisdiction. De

these changes, please call the number on the back of your Card. We May Contact You Effective September 1, 2012, the We may contact you section, in Pan 2 of your Cardmember Agreement, is replaced with the following: Servicing and collections If we need to contact you to service your account or to co

d Person means the Basic Cardmember, each Additional Cardmember, and each of these Cardmember's spouses or Domestic Partners and dependent children. Spouse includes the person to whom you are married, including your same-sex partner in your marriage that was legally performed in another jurisdiction. De

these changes, please call the number on the back of your Card. We May Contact You Effective September 1, 2012, the We may contact you section, in Pan 2 of your Cardmember Agreement, is replaced with the following: Servicing and collections If we need to contact you to service your account or to co