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(mrn/dcl/yyyy) ► Count of Birth 4.a. In Care Of Name 9. Country of Citizenship 4.b. Street Number and Name SLovit-11\- 4.c. Apt. 2 Ste. 10. U.S. Social Security Number (if an ) K Flr. 0 4.d. City or Town NEW t i ORIC Entry Information 4.e. State 4.f. ZIP Code 100toS 11. Date of Last Entry into the U
tial witness to that trafficking. 3. Name checks have been completed in the principle law enforcement databases on the person named in the request (National Crime Information Center and any other databases available) and, as appropriate, information from foreign law enforcement agencies. Criminal history check results based on
d. City or Town 6.e. State 0 6.f. ZIP Code Other Information 7. Date of Birth (mm/dd/yyyy) ► 8. Count of Birth 9. Count of 'fizen hi 10. U.S. Social Security Number if an City or Town NEAN otkg Entry Information State NY 4.1. ZIP Code 11. Date of Last Entry into the United States Is your current U
tial witness to that trafficking. 3. Name checks have been completed in the principle law enforcement databases on the person named in the request (National Crime Information Center and any other databases available) and, as appropriate, information from foreign law enforcement agencies. Criminal history check results based on
Town 6.e. State O Flr. O 6.1. ZIP Code Other Information 7. Date of Birth (nmildcliyyyy) 10. 8. un of Birth 9. Coun of Citizenshi 10. U.S. Social Security Number if an Entry Information 11. Date of Last Entry into the United States (mni/dellyyyy) ► oi/a/e301° 12. Place of Last Entry into the Unite
tial witness to that trafficking. 3. Name checks have been completed in the principle law enforcement databases on the person named in the request (National Crime Information Center and any other databases available) and, as appropriate, information from foreign law enforcement agencies. Criminal history check results based on
Entities connected to both U.S. Social Security and National Crime Information Center

Jeffrey Epstein
PERSON
Homeland Security
ORGANIZATION
United States
LOCATIONU.S. Citizenship and Immigration Services
ORGANIZATIONNew York Field Office
LOCATIONFBI
ORGANIZATION
Department of Homeland Security
ORGANIZATIONPreparer
ORGANIZATIONAlbany
LOCATIONthe Social Security Administration
ORGANIZATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONU.S. Immigration and Customs Enforcement
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
ORGANIZATION