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ature Interpreter's Mailing Address 3.a. Street and Name 3.b. K Apt. 3.c. City or 3.d. State 3.f. Province 3.g. Postal 3.h. Country Number K Ste. Town Preparer's 1.a. 1.b. 2. Preparer's Full Name Preparer's Family Name (Last Name) K Flr. Preparer's Given Name (First Name) 3.e. ZIP C
III Page 1 of 7 EFTA01699786 Part 2. Information About You (continued) Your U.S. Mailing Address 5.a. 5.b. Street Number and Name 5.e. Apt. K Ste. K Flr. 5.d. City or Town 5.e. State Naze) uor- 5.f. ZIP Code I 00105 6. Is your current mailing address the same as your physical address?
proceedings? 0 Yes Ej No (if yes, where and when) City, State: 5. When did the Victim enter the United States? 1st Entry 09/0145 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight oi3/40 5,1* -00,09;**000:00.111M01
31228 Part 2. Information About You (continued) Your U.S. Mailing Address 5.a. In Care Of Name (if any) 5.b. Street Number and Name 5.c. Apt. K Ste. 5.d. City or Town 5.e. State ■ 51 ZIP Code 6. Is your current mailing address the same as your h sical address? NOTE: If you answered "No" to
r deportation proceedings? K Yes ❑X No (if yes, where and when) City, State: 5. When did the Victim enter the United States? Ma 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight Part D: Specific Information Perta
84013 Part 2. Information About You (continued) Your U.S. Mailing Address 5.a. In Care Of Name (if any) 5.b. Street Number and Name 5.c. Apt. K Ste. 5.d. City or Town 5.e. State ■ 51 ZIP Code 6. Is your current mailing address the same as your h sical address? NOTE: If you answered "No" to
r deportation proceedings? K Yes ❑X No (if yes, where and when) City, State: 5. When did the Victim enter the United States? Ma 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight Part D: Specific Information Perta
Entities connected to both K Ste and Port of Entry

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