Epstein Secrets

cant's Signature lOa. Date PRIVACY ACT NOTICE Authori ty for Co lle cting I nformation: E . O. 10450; 5 USC 1303-1305; 42 USC 2 1 65 and 2455; 22 USC 2585 and 2519; and 5 USC 3301 Purposes and Uses : Information provided on this form will be furnished to individuals in order to obtain information rega

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

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

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

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

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

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 be furnished to individuals in order to obtain information regar

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