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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
SECURITY U.S. Immigration and Customs Enforcement REQUEST FOR CONTINUED PRESENCE Part A.Informatlon on the; Vktlm;.` 1. Name: (Last) 2. Date of Birth (mo., day, yr) 5. Alias(es) 8. Passport Number 11. Social Security Number (First) 3. Country of Birth 6. Gender (check one) Male Female (Middle)
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
Y U.S. Immigration and Customs Enforcement REQUEST FOR CONTINUED PRESENCE 'POPfliffoYminifion'ronttO\Vatitt 1. Name: (Last) (First) 2. Date of Birth (mo., day, yr) 3. Country of Birth 5. Alias(es) 8. Passport Number 11. Social Security Number (Middle) 4. Country of Citizenship 6. Gender (check o
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
ms Enforcement REQUEST FOR CONTINUED PRESENCE 1bartA: InforatatiOnon'theitiopm. N.3:7 -.72.44t''> ;a14cir iCPIAC:' 1. Name: (Last) 2. Date of Birth (mo., day, yr.) 6. Allas(es) 8. Passport Number 11. Social Security Number (First) 3. Country of Birth 6. Gender (check one) Male J Female (Midd
Entities connected to both U.S. Social Security and Birth (mo.
U.S. Citizenship and Immigration Services
ORGANIZATION
Jeffrey Epstein
PERSON
Homeland Security
ORGANIZATIONNew York Field Office
LOCATION
Department of Homeland Security
ORGANIZATIONPreparer
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATION
Birth
PERSONFederal, State
ORGANIZATIONMonitoring Case
ORGANIZATIONContact Information, Certification
ORGANIZATIONthe Social Security Administration
ORGANIZATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONNational Crime Information Center
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONAlbany
LOCATIONMonitoring Group
ORGANIZATION