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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
hed my original Form I-94 or I-94W. 1.d. 0 I am applying to replace my Form 1-95 because it was If you are unable to provide the original of your Form I-94. mutilated. I have attached my original Form 1-95. 1-94W, or 1-95, provide the following information: Le. g I was not issued Form 1-94 when I was
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
st describes your reason for requesting an initial or replacement document. (Select only one box) l.a. O 1 am applying to replace my lost or stolen Form I-94 or I-94W. 1.b. O I am applying to replace my lost or stolen Form 1-95. 1.c. O I am applying to replace my Form 1-94 or I-94W because it was mutil
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
cribes your reason for requesting an initial or replacement document. (Select only one box) La. 1.b. O I am applying to replace my lost or stolen Form I-94 or I.94W. K I am applying to replace my lost or stolen Form I-95. Lc. K I am applying to replace my Form I-94 or I-94W because it was mutilated.
Entities connected to both Preparer and Form I-94

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