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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
active investigation is underway by a law enforcement agency that requires the assistance of this subject. Certification for Continued Presence by Requesting Law Enforcement Agency FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE EFTA00173130 oy2.1-12-o 2-o r S afure [df Authonzinti giedl] Elate Printed Ntine [of Authori
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
active investigation is underway by a law enforcement agency that requires the assistance of this subject. Certification for Continued Presence by Requesting Law Enforcement Agency FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE EFTA00173740 Signature [of Authorizing Official] Date Printed Name [of Authorizing Official]
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
active investigation is underway by a law enforcement agency that requires the assistance of this subject. Certification for Continued Presence by Requesting Law Enforcement Agency FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE EFTA01699756 Signature [of Authorizing Official] Date Printed Name [of Authorizing Official]
Entities connected to both U.S. Social Security and Requesting Law Enforcement Agency

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