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Uzi) • if outside the 10. The above listed information is true and correct. Applicant's Signature %ty4le 10a. Date /afrb PRIVACY ACT NOTICE Authority for Collecting Information: E.O. 10450: 5 CSC :303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519; and 5 USC 3301 purposes end Uses: Information provided on this form will
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outside the 10. The above listed information is true and correct. Applicant's Signature %ty4le (979,yi,;\ 10a. Date /afril PRIVACY ACT NOTICE Authority for Collecting Information: E.O. 10450; 5 CSC :303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519; and 5 SSC 3301 purposes end Uses: Information provided on this form will
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d country if outside the U.S.A) WM • 10. The above listed information is true and correct. Applicant's Signature lOa. Date PRIVACY ACT NOTICE Authority for Collecting Information: E.O. 10450; 5 CSC :303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519; and 5 USC 3301 purposes end Uses: Information provided on this form will
Entities connected to both NEW YORK STATE DEPARTMENT OF STATE and Authority for Collecting Information

United States
LOCATIONUSC 2585
ORGANIZATION
Jeffrey Epstein
PERSONFederal Bureau of Prisons
ORGANIZATIONFederal, Municipal County
ORGANIZATIONNational Crime Information Center
ORGANIZATIONInmate Legal Activities
ORGANIZATIONSarah M. Sacks
PERSON
Sarah Kellen
PERSONMorse
PERSONthe State of New York
LOCATIONO'Brien
PERSONthe Legal Department
ORGANIZATIONSociety National Office
ORGANIZATIONMotel Nittalijey
ORGANIZATIONBennett M. Epstein
PERSONfarvey E.
PERSONNikolei Niftalijev
PERSONthe Mitigation Specialist/ Doctors
ORGANIZATION
Mark Epstein
PERSON