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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
FEB6E-AL PIA2ft Contact Information K Flr. 4. Interpreter's Daytime Telephone Number 3.c. City or Town NEW YORK 5. 3.d. State 3.e. ZIP Code Interpreter's Mobile Telephone Number (if any) N V Idris 3.f. Province 6. Interpreter's Email Address (if any) 3.g. Postal Code 3.h. Country Interpreter's Certification I certify
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.
E-f\L PLAZIN Contact Information O Flr. 4. Interpreter's Daytime Telephone Number NEW YOIZW--- 3.c. City or Town 5. 3.d. State 3.e. ZIP Code Interpreter's Mobile Telephone Number (if any) NV 10276 3.1. Province 6. Interpreters Email Address (if any) 3.g. Postal Code 3.h. Country Interpreter's Certification I certify,
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.
et Number and Name K Apt. K Ste. Contact Information K Flr. 4. Interpreter's Daytime Telephone Number 3.c. City or Town 5. 3.d. State 3.e. Interpreter's Mobile Telephone Number (if any) ZIP Code 3.f. Province 6. Interpreter's Email Address (if any) 3.g. Postal Code 3.h. Country Interpreter's Certification I certify,
Entities connected to both K Select and Interpreter's Mobile Telephone Number

Jeffrey Epstein
PERSON
Homeland Security
ORGANIZATIONAlbany
LOCATIONU.S. Citizenship and Immigration Services
ORGANIZATION
Department of Homeland Security
ORGANIZATIONthe Social Security Administration
ORGANIZATIONNew York Field Office
LOCATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONU.S. Social Security
ORGANIZATIONNational Crime Information Center
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATION