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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
er. 3.a. Street Number and Name Preparer's Full Name 3.b. O Apt. K Ste. O Flr. l.a. Preparer's Family Name (Last Name) 3.c. City or Town I.b. Prepares Given Name (First Name) 3.d. State 3.e. ZIP Code 3.1. Province 2. arees Business or Organization Name (if any) 3.g. Postal Code 3.h. Country
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
er. 3.a. Street Number and Name Preparer's Full Name 3.b. O Apt. K Ste. O Flr. l.a. Preparer's Family Name (Last Name) 3.c. City or Town I.b. Prepares Given Name (First Name) 3.d. State 3.e. ZIP Code 3.1. Province 2. arees Business or Organization Name (if any) 3.g. Postal Code 3.h. Country
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 •
her than the Applicant Preparer's Full Name Provide the following information concerning the preparer: 1.a. Preparers Family Name (Last Name) Lb. Prepares Given Name (First Name) 2. Prepares Business or Organization Name Preparer's Mailing Address 3.a. Street Number and Name 3.b. Apt. K Ste. K Fl
Entities connected to both El Authorization/Extension and Prepares
the Social Security Administration
ORGANIZATIONParole and Law Enforcement Programs Unit
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATIONNew York Field Office
LOCATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATION
Michael C.Green
PERSONLast Entry
ORGANIZATIONContact Information, Certification
ORGANIZATIONthe NYS Division of Criminal Justice Services
ORGANIZATIONFBI
ORGANIZATIONPort of Entry
ORGANIZATIONApplication for Replacement
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATION
Homeland Security
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATION
Jeffrey Epstein
PERSONFederal Bureau of Investigation - New York
ORGANIZATION