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y/town/village, state/province, and country where you were born. 19.a. Citv/TownNilla e of Birth 19.b. State/Province of Birth 19.c. Country of Birth =IS 20. Datc of Birth (mm/dd/yyyy) I Information About Your Last Arrival in the United States 21.a. Form 1-94 Arrival-Departure Record Number (if
own ►YEW yo 3.d. State 3.e. ZIP Code Ny 10278 31 Province 3.g. Postal Code 3.h. Country N I reb 517:116 Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparers Fax Number 6. Preparer's E-mail Address 7.a. IR I am not an attorney or accredited representative but h
N Page I of 20 EFTA00525459 Part 2. Information About You (Person applying for naturalization) (continued) A- 3. Other Names You Have Used Since Birth (include nicknames, aliases, and maiden name, if applicable) Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) 4. Name
n, Declaration, and Signature of the Person Preparing This Application, if Other Than the Applicant (continued) Preparer's Contact Information 4. Preparer's Daytime Telephone Number 6. Preparer's Email Address (if any) A- 5. Preparer's Mobile Telephone Number (if any) Preparer's Statement 7. A. K
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
IP Code N I D2 78 3.f. Province 3.g. Postal Code 3.h. Country 2a FED6_12AL PLA2A FIr. 0 Li N ran smerec Pireparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number 6. Preparer's E-mail Address 7.a. g I am not an attorney or accredited representative but h
Entities connected to both Birth and Preparer

Jeffrey Epstein
PERSONLeon Black
PERSON
United States
LOCATION
George W. Bush
PERSONFBI
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATION
Maine
LOCATION
the Internal Revenue Service
ORGANIZATION
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATION
New York City
LOCATIONAlbany
LOCATIONU.S. Social Security
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONFiler
PERSON
U.S. Treasury
ORGANIZATION
Joi Ito
PERSON
NEW YORK NY
LOCATION
New York State
LOCATIONNew York Field Office
LOCATION