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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
io laws. nature 3.b. Date of Signature (mm/dd/yyyy) ► 1.11Lt /iota) Applicant's Contact Information 4. Applicant's Daytime Telephone Number 5. Applicant's Mobile Telephone Number 6. Applicant's E-mail Address Part 5. Contact Information, Certification, and Signature of the Interpreter Interpreter's Full Name Provide the fo
vince 3.g. Postal Code 3.b. Country 2lo PED62AL PLAZA Flr. K NEW yotk 3.e. ZIP Code 10278 UNIT-6Th SikreS Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Fax Number 6. Preparer's E-mail Address 7.a. xi I am not an attorney or accredited representative but
e, and correct. Applicant's Contact Information Applicant's Signature 3. Applicant's Daytime Telephone Number 7.a. A licant's Si nature S 4. Applicant's Mobile Telephone Number (if any) 7.b. Date of Signature (mm/dd/yyyy) oi./I412620 5. A licant's Email Address (if any) NOTE TO ALL APPLICANTS: If you do out this appli
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
3.a. Applicant's Signature S 3.b. Date of Signature (mm/dd/yyyy) ► Applicant's Contact Information 4. Applicant's Daytime Telephone Number 5. Applicant's Mobile Telephone Number 6. Applicant's E-mail Address Part 5. Contact Information, Certification, and Signature of the Interpreter Interpreter's Full Name Provide the fo
Entities connected to both Preparer and Applicant's Mobile Telephone Number

Jeffrey Epstein
PERSONAlbany
LOCATION
Homeland Security
ORGANIZATIONthe Social Security Administration
ORGANIZATIONNew York Field Office
LOCATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONNational Crime Information Center
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATION
Department of Homeland Security
ORGANIZATIONFederal, State
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATIONContact Information, Certification
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONBirth (mo.
LOCATION