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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 be furnished to individuals in order to obtain information regar
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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 be furnished to individuals in order to obtain information regar
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t. 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 be furnished to individuals in order to obtain information regar
Entities connected to both NEW YORK STATE DEPARTMENT OF STATE and USC 2585

Jeffrey Epstein
PERSON
United States
LOCATIONFederal, Municipal County
ORGANIZATIONAuthority for Collecting Information
ORGANIZATIONInmate Legal Activities
ORGANIZATIONFederal Bureau of Prisons
ORGANIZATIONNational Crime Information Center
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