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be completed by Federal, state. local, or tribal law enforcement agencies for victims under the Victims of Trafficking and Violence Protection Act (VTVPA). Public Law 106-386, as amended. PART 1. Victim Information I. Full Legal Name Family Name (Last Name) Given Maine (Pint Name) Middle Name (if
3. 4. 5. 6. Name of Certifying Agency Federal Bureau of Investigations Name of Cenifying Official Title of Certifying Official Special Agent Division/Office of Certifying Official New York Field Office Agency Mailing Address Street Number and Name 26 Federal Plaza City or Town New York Daytime Telephone Number
be completed by Federal, state, local, or tribal law enforcement agencies for victims under the Victims of Trafficking and Violence Protection Act (VTVPA). Public Law 106-386, as amended. PART 1. Victim Information 1. Full Legal Name (First Name) Middle Name (if any) 2. Provide any other names y
ion 1. 2. 3. 4. 5. 6. Name of Certifying Agency 'Federal Bureau of Investigations Name of Certifying Official Title of Certifying Official Division/Office of Certifying Official Agency Mailing Address Street Number and Name 26 Federal Plaza City or Town New York Daytime Telephone Number 7. Fax Number For USC
be completed by Federal, state, local, or tribal law enforcement agencies for victims under the Victims of Trafficking and Violence Protection Act (VTVPA). Public Law 106-386. as amended. PART 1. Victim Information 1. Full Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if
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
be completed by Federal, state, local, or tribal law enforcement agencies for victims under the Victims of Trafficking and Violence Protection Act (VTVPA), Public Law 106-386, as amended. PART 1. Victim Information I. Full Legal Namc Family Name (Last Name) Given Name (First Name) Middle Name (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 VTVPA and Division/Office of Certifying
FBI
ORGANIZATION
Ghislaine Maxwell
PERSONU.S. Citizenship and Immigration Services
ORGANIZATION
Jeffrey Epstein
PERSONDelaration of Law Enforcement
ORGANIZATIONReloc Sent
LOCATIONEl Completed
LOCATIONU.S. Social Security
ORGANIZATION
Birth
PERSONDaytime Telephone Number
ORGANIZATIONItem B.
PERSONEl Federal
ORGANIZATIONEl Tribal
ORGANIZATIONEl Law Enforcement
ORGANIZATIONDSC 1591(a
ORGANIZATIONDSC 2423(a
ORGANIZATIONSignature of Law Enforcement
ORGANIZATIONSignature of Supervisor
ORGANIZATION
Slovakia
LOCATIONNew York Field Office
LOCATION