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of which he o she is a victim, I will notify USCIS. I. Signature of Certifying Official (sign in ink) 4 2. Date of Signature (miniddiyyyy) 3. Daytime Telephone Number 4. Fax Number Form 1.918 Supplement a 04/24/2019 Page 4 g 5 A A EFTA00155348 Part 7. Additional Information 1 If you need extra space to comp
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
Date Receipt Remarks 26 Federal Plaza City or Town (ILSPI VP rode Lank -A Apt. Ste. Flr. Number 0 0 El State ZIP Code NY New York 6. Daytime Telephone Number 7. Fax Number 102711 Form 1-914. Supplement B Edition 12/C0/21 Page I EFTA00156636 Part 2. Agency Information (continued) 8. Agency Type El
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
Date Date Reloc Rec'd Date Date Receipt Remarks 26 Federal Plaza City or Town New York IMPS ZIP Co* Loging2 Apt. Ste. Flr. State NY 6. Daytime Telephone Number 7. Fax Number Number ZIP Code 10278 Form 1-914. Supplement B Edition 12/02/21 Page EFTA01653122 Part 2. Agency Information (continued) 8. A
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 Daytime Telephone Number and Division/Office of Certifying
U.S. Citizenship and Immigration Services
ORGANIZATIONFBI
ORGANIZATION
Ghislaine Maxwell
PERSON
Jeffrey Epstein
PERSON
Birth
PERSONU.S. Social Security
ORGANIZATIONReloc Sent
LOCATIONVTVPA
ORGANIZATIONDelaration of Law Enforcement
ORGANIZATION
United States
LOCATIONItem A.
PERSON