Epstein Secrets

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

quest needs lobe faxed to the respective Legal Department for the institution you need to visit. Please be advised that it is the responsibility of the Mitigation Specialist/ Doctors to make her/his sponsoring attorney aware of the above procedures. The enclosed Sponsoring Statement form can be reproduced locally. Page 10 of 10

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

quest needs lobe faxed to the respective Legal Department for the institution you need to visit. Please be advised that it is the responsibility of the Mitigation Specialist/ Doctors to make her/his sponsoring attorney aware of the above procedures. The enclosed Sponsoring Statement form can be reproduced locally. Page 10 of 10

y and country if outside the U.S.A) 10. The above listed information is true and correct. Applicant's Signature 1 C;i1 . Date PRIVACY ACT NOTICE Authority for Collecting Information: E.O. 10450; 5 USC 1303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519; and 5 USC 3301 Purposes and dans; Information provided on this form will

uest needs to be faxed to the respective Legal Department for the institution you need to visit. Please be advised that it is the responsibility of the Mitigation Specialist/ Doctors to make her/his sponsoring attorney aware of the above procedures. The enclosed Sponsoring Statement form can be reproduced locally. Page 10 of 10