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C: CIVIL CONTEMPT MATERIAL WITNESS Date of Offense: iffh1//ii/4 Date of Arrest:02/041.4/4 Place of Arrest: State of Birth .1..(k Country of.Birth. Citizenship v;. Cu - Height Ft: • In: / Weight /6,0 Hair. /.)/4, Eyes &en Scars /.Marks /Tattoos Injuries / Medication 1 Arraigned
24 Hour Number Phone/24 Hour Number Date / Time Sentry Load Data: (Must Initial) Name Search,Compileted by: Clearance/Separet, Checked by: • (OPTIONAL. ARS Code b t.l Staff Init. Add AKA' Create Cash Account Deposit Cash Detainers Court Clothing Bag I Amt. RIGHT THUMBPRINT Original-for
ffense: Date of Arrest:-711)4 19. Place of Arrest: t 151tInil • State of Birth fly Height Ft: t, In:0-) Injuries / Medicatibn Country. of Birth' ‘)% WeighSt.) t .‘ Hair Citizenship s Eyes C2 .Current Addrese1.6(0-11l\p/ 'Zip Code -• -YkVilse\ 1)1)‘ -. Cr\c t\?\- t1L 1ctw Scars I. Mar
rch Completed by:. Clearance/Separate Chocked by:''' i i1 Phone/24 Hour Number Phone/24 Hour Number big Official (NWN!) • - 34 ri ')c Pr: at (OPTIONAL' USE) ARS Code. Staff Init. Add AKA's Create Cash Account Deposit Cash Amt. • Detainers Court Clothing Bag a Date / Time RIGHT THUMBPRINT
tate/province, and country where you were born. 19.a. CityfrownNillage of Birth 19.b. State/Province of Birth 19.c. Country of Birth 20. Date of Birth (mm/dcVyyyy) Information About Your Last Arrival in the United States 21.a. 21.b. 21.e. 21.d. Form I-94 Arrival Ito Passport Number Departu
or federal law enforcement agencies: criminal justice agencies: and agencies responsible for national security or public safety PASTE PHOTO HERE (OPTIONAL) FD-353 (Rev. 9-9-13) U.S. GOVERNMENT PUBLISHING OFFICE:OW.02017 11:5138 EFTA01699749 r : EE REVERSE SIDE FOR FukTHER iNSTRuC - IONS PERSONAL
Entities connected to both Birth and OPTIONAL

Jeffrey Epstein
PERSONLeon Black
PERSON
George W. Bush
PERSON
Samantha Power
PERSONDarren Indyke
PERSON
Department of Justice
ORGANIZATION
Ghislaine Maxwell
PERSON
United States
LOCATION
Palm Beach
LOCATION
Julie K. Brown
PERSON
Prince Andrew
PERSON
New York City
LOCATION
John F. Kennedy
PERSON
Richard Kahn
PERSONFBI
ORGANIZATION
Maine
LOCATION
Barry Diller
PERSON
Prince Charles
PERSON
New York State
LOCATION
Alan Dershowitz
PERSON