3
Shared Docs
3
Same-Page
3 / 3
Mentions
Federal O County State City Officer Name: Grey Eyes: Blue Phone: ( ) Officer Name: Phone: ( ) Officer Name: Phone: ( ) County Out of State Travel Information (Complete if permanent, temporary, or transient address is out of state) O Permanently leaving Florida to establish a residence In another state O
ST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(1)). PLEASE READ CAREFULLY REFORE SIGNING As a sexual predator (Florida Statute 775.21) or sexual offender (Florida Statute 943.0435, 944.607, or 985.4815), I am required by law to abide by the requirements listed on this form. BY SIGN
ede-al Canty Stale City Weight: 180 lbS Hah: Officer Name: Phone ( ) Officer Name: Phone: ( ) OffiCer Name: Phone'. ( ) County Out of State Travel Information (Complete If permanent, temporary, or transient address Is out of state) Permanently leaving Florida b establish a residence In another state/countr
TRATION INFORMATION IS PUBLISHED ON THE FDLE PUBLIC SEXUAL PREDATOR AND OFFENDER WEBSITE. PLEASE READ CAREFULLY BEFORE SIGNING Asa sexual predator (Florida Statute 775.21) or sexual offender (Florida Statute 943.0435, 944.607, or 985.4815), I am required by law to abide by the requirements listed on this form. BY SIGN
eight: 180 lbS Halt State Cry Officer Name: Grey Phone ( Officer Name: Phone: ( ) Officer Name' Canty Pl,nne ( ) Eyes: roue Out of State Travel Information (Complete If permanent, temporary, or transient address Is out of state) O Permanently leaving Florida to establish a residence in another stale/co
ISTRATION INFORMATION IS PUBUSHED ON THE FDLE PUBUC SEXUAL PREDATOR AND OFFENDER WEBSITE. PLEASE READ CAREFULLY BEFORE SIGNING As a sexual predator (Florida Statute 775.21) or sexual offender (Florida Statute 943.0435, 944.607, or 985.4815), I am required by law to abide by the requirements fisted on this form. BY SIGN
Entities connected to both State Travel Information and Florida Statute 775.21

Jeffrey Epstein
PERSONLeon Black
PERSONDHSMV
ORGANIZATIONthe Department of Highway Safety and Motor Vehicles
ORGANIZATIONChristopher Steele
PERSON
Palm Beach
LOCATION
Tallahassee
LOCATIONSept & Dec
ORGANIZATIONUniversity/School Name
ORGANIZATION
Land Rover
ORGANIZATION
Dodge
ORGANIZATION
Financial Trust Company
ORGANIZATIONBentley
ORGANIZATIONColor/Color Scheme
ORGANIZATION
Chevrolet
ORGANIZATION
Jane Fonda
PERSONMeese
PERSON
Vicky Ward
PERSON
Mobile
LOCATIONHorne
LOCATION