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or print in black ink Part 1. Information About You U.S. Physical Address To Be Completed by an Attorney or Accredited Representative, if any. K Select this box if Form O-28 is attached to represent the applicant. Attorney State License Number I. Alien Registration Number (A-Number) 6.a. In Ca
ant's Contact Information 4. Applicant's Daytime Telephone Number 5. Applicant's Mobile Telephone Number 6. Applicant's E-mail Address Part 5. Contact Information, Certification, and Signature of the Interpreter Interpreter's Full Name Provide the following information concerning the interpreter: l.a. Interpreter's Family
amp Action Block Valid From K Authorization/Extension Valid Through Alien Registration Number A- , Remarks To be completed by an attorney or K Select this box if Form G-28 Attorney or Accredited Representative Board of Immigration Appeals (BIA)- accredited representative (if any). is attached.
ntact Information 4. 5. 6. A licant's Da time Tel hone Number A licant's Mobile Tele hone Number E-mail A licant's Address --/N/24o Part 5. Contact Information, Certification, and Signature of the Interpreter Interpreter's Full Name Provide the following information concerning the interpreter: 1.a. Interpreter's Family
U.S. physical address in Item Numbers 6.a. - 6.1. 1 1 La. In Care Of Name To Be Completed by an Attorney or Aerredited Representative, if any. K Select this box if Form G-28 is attached to represent the applicant. Attorney State License Number Lb. Street Nut and Name 6.c. Apt. 0 Ste. 0 FIr.
tforingthit 4. Interpreter's Daytime Telephone Number 5. Interpreter's E-mail Address Fox= I-102 10/19/17 N Page 3 of 4 EFTA01699765 Part 5. Contact Information, Certification, and Signature of the Interpreter(continued) Interpreter Certification I certify that: I am fluent in English and ,which is the same language
Entities connected to both K Select and Contact Information, Certification
National Crime Information Center
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATION
Department of Homeland Security
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATIONthe Social Security Administration
ORGANIZATIONNew York Field Office
LOCATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONAlbany
LOCATION
Jeffrey Epstein
PERSONParole and Law Enforcement Programs Unit
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATION
Homeland Security
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATIONBirth (mo.
LOCATION