Epstein Secrets

(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

a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Print Name and Title) (Date) (Monitoring Case Agent's Signature) (Date) (Print Name and Title) Request for Continued Presence FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE ICE Form 73-03

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

itoring agent must be designated in the appropriate jurisdiction. —1 I (Monitoring Group Supervisor's Signature) (Date) (Print Name and Title) (Monitoring Case Agent's Signature) (Date) (Print Name and Title) Request for Continued Presence FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE ICE Form 73-03

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

a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Date) (Print Name and Title) (Monitoring Case Agent's Signature) (Date) (PrintRame and Title) Request for Continued Presence FOR OFFICIAL USE ONLY! LAW ENFORCEMENT SENSITIVE ICE Form 73-031