3
Shared Docs
3
Same-Page
3 / 3
Mentions
l names, use the space provided in Part 7. Additional Information. 3.a. Family Na (Last Na 3.b. Given Na (First Nam 3.c. Middle Na 4. Date of Birth (nun/dd/yyyy) 5. Gender O Male Ela Female Part 2. Agency Information 1. Name of Certifying Agency Federal Bureau of Investigations Name of
Bureau of Investigations Name of Certifying Official 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 3. Title and Division/Office of Certifying Official Name of Head of Certifying Agency 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 5.a. Street Number and
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)
Information 1. Name of Certifying Agency Federal Bureau of Investigations 2. Name of Certifying Official 3. Title of Certifying Official 4. Division/Office of Certifying Official 5. Agency Mailing Address Street Number and Name For USCIS Use Only Returned Date Date Resubmitted Date Date Reloc Sent Date Da
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
ifying Agency Federal Bureau of Investigations 2. Namc of Certifying Official 'Amanda Young 3. Title of Certifying Official Special Agent 4. Division/Office of Certifying Official 'New York Field Office 5. Agency Mailing Address Street Number and Name For USCIS Use Only Returned Date Date Resubmitted Date Da
Entities connected to both Birth and Division/Office of Certifying

Jeffrey Epstein
PERSON
Ghislaine Maxwell
PERSONFBI
ORGANIZATION
United States
LOCATIONU.S. Citizenship and Immigration Services
ORGANIZATIONU.S. Social Security
ORGANIZATIONDaytime Telephone Number
ORGANIZATIONReloc Sent
LOCATIONDelaration of Law Enforcement
ORGANIZATIONVTVPA
ORGANIZATIONNew York Field Office
LOCATION
Slovakia
LOCATIONItem A.
PERSON