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section, use the space provided in Part 9. Additional Information. Family Name (Last Name) Given Name (First Name) Middle Name (if any) Date of Birth (ddirrun/yyyy) 4. Gender or Sex El Male El Female El Other Alien Registration Number (A-Number) (if any) P. A- U.S. Social Security Number (SSN)
ddle Name (if any) Date of Birth (ddirrun/yyyy) 4. Gender or Sex El Male El Female El Other Alien Registration Number (A-Number) (if any) P. A- U.S. Social Security Number (SSN) (if any) .r Part 2. Agency Information 1. Name of Certifying Agency Federal Bureau of Investigations 2. Name of Certifying Offici
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
(mrn/dcl/yyyy) ► Count of Birth 4.a. In Care Of Name 9. Country of Citizenship 4.b. Street Number and Name SLovit-11\- 4.c. Apt. 2 Ste. 10. U.S. Social Security Number (if an ) K Flr. 0 4.d. City or Town NEW t i ORIC Entry Information 4.e. State 4.f. ZIP Code 100toS 11. Date of Last Entry into the U
e the space provided in Part 9. Additional Information. Family Name (Last Name) Given Namc (First Name) Middle Name (if any) 3. 5. 6. Date of Birth (dd/mm/yyyy) 4. Gender or Sex K Male ❑X Female K Other Alien Registration Number (A-Number) (if any) ► A- U.S. Social Security Number (SSN) (if
me (if any) 3. 5. 6. Date of Birth (dd/mm/yyyy) 4. Gender or Sex K Male ❑X Female K Other Alien Registration Number (A-Number) (if any) ► A- U.S. Social Security Number (SSN) (if any) Part 2. Agency Information I. Name of Certifying Agency Federal Bureau of Investigations 2. Namc of Certifying Official
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
would like to use in the spaces provided below. Family Name (Last Name) O Yes O No Given Name (First Name) Middle Name (if applicable) _J 5. U.S. Social Security Number (if applicable) 6. USCIS Online Account Number (if any) ► 7. Gender El Male I] Female 10. Country of Birth 8. Date of Birth (mm/ddi
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
Town 6.e. State O Flr. O 6.1. ZIP Code Other Information 7. Date of Birth (nmildcliyyyy) 10. 8. un of Birth 9. Coun of Citizenshi 10. U.S. Social Security Number if an Entry Information 11. Date of Last Entry into the United States (mni/dellyyyy) ► oi/a/e301° 12. Place of Last Entry into the Unite
Entities connected to both Birth and U.S. Social Security

Jeffrey Epstein
PERSONLeon Black
PERSON
Ghislaine Maxwell
PERSON
United States
LOCATION
Department of Justice
ORGANIZATIONFBI
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATION
Maine
LOCATION
Department of Homeland Security
ORGANIZATION
Homeland Security
ORGANIZATIONDaytime Telephone Number
ORGANIZATION
FedEx
ORGANIZATIONNew York Field Office
LOCATIONPreparer
ORGANIZATION
Michael C.Green
PERSONAlbany
LOCATIONthe NYS Division of Criminal Justice Services
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONDivision/Office of Certifying
ORGANIZATIONHomeland Security Investigations
ORGANIZATION