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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?
thorization Pepartineat-Of SOmetanctSecurity U.$: Citizenship andimmigratibn Services. TiRaS . Form T-7.65 OMB Ho. 1615.0040 Expires 05/31/2020 El Authorization/Extension ValidTrom . . teeStinlit Adtion block `For WSCISI Vat I 0 Authorization/EXtention Valid:Through 0 1'4 i Alien Registration Number A- I •
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
ent of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-765 OMB No. 1615-0040 Expires 05/31/2020 For USCIS Use Only El Authorization/Extension Valid From Fee Stamp Action Block 0 Authorization/Extension K Valid Through Allen Registration Number A-L i I Remarks To be completed by an
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
ent of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-765 OMB No. 1615-0040 Expires 05/31/2020 For USCIS Use Only El Authorization/Extension Valid From Fee Stamp Action Block 0 Authorization/Extension K Valid Through Allen Registration Number A-L i I Remarks To be completed by an
Entities connected to both K Ste and El Authorization/Extension

Homeland Security
ORGANIZATIONFBI
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATIONNew York Field Office
LOCATIONLast Entry
ORGANIZATIONContact Information, Certification
ORGANIZATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONPort of Entry
ORGANIZATIONApplication for Replacement
ORGANIZATION
United States
LOCATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONPrepares
PERSON
Jeffrey Epstein
PERSONNew York State Division of Criminal Justice Services
ORGANIZATIONFederal Bureau of Investigation - New York
ORGANIZATIONBoard of Immigration Appeals
ORGANIZATION