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tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
R ISSUING OFFICE ONLY O PPT BK CORO PPT BK SM O PPT CD CM O PPT CD Sal 0 Marriage Certificate Date of MarriagelPlace Issued: o Court Order Date Filedtoun: From To' O Other 0 Attached: 1111111 11111 Date !)111 SS' gft 111 11 For Issuing Office Only —0 , Bk Fee _ Cd Fee EF Postage
tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
UING OFFICE ONLY El PPT BK CM 0 PPT BK SM 0 PPT CD C/R 0 PPT CD Sal O Marriage Certificate Date of MarriagelPlace Issued: o Court Order Date Filedtoun: From To: El Other: O Attached: 1111111 11111 Dale 111III 111{111,111 111 11 For Issuing Office Only —0 , Bk Fee Cd Fee. EF Po
tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
ING OFFICE ONLY EI PPT BK CM 0 PPT BK SIR 0 PPT CD C/R O PPT CD SIR O Marriage Certificate Date of Marriage+Place Issued: O Court Order Date Filedtoun: From To' 0 Other. K Attached: For Issuing Office Only —0 , Bk Fee Cd Fee. EF Postage Other 1111111 11111 Date DS-82 08-2013
tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
ISSUING OFFICE ONLY K PPT BK CM 0 PPT BK SIR K PPT CD C/R O PPT CD SfR O Marriage CerMicate Date of MarriagelPiace Issued: O Court Order Date Filedtoun: From To: O Other O Attached: 1111111 11111 Date IIUIIII~IIIHI 111I111 111 11 For Issuing Office Only —0 , Bk Fee Cd Fee. EF Pos
tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
ISSUING OFFICE ONLY 0 PPT BK CM 0 PP7 BK SAR K PP7 CD C/R O PP7 CD SIR O Marriage Certificate Date of MerriagelPiece Issued: ID Court Order Date Filedtoun: From To' 0 Other K Attached: 1111111 11111 Date 111,111 DSS2 3(s_ 111 11 For Issuing Office Only Bk Fee _ Cd Fee EF Postage O
tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
SUING OFFICE ONLY K PPT BK CORO PPT BK SIR K PPT CD C/R 0 PPT CD SfR O Marriage Certificate Date of MarriagelPiace Issued: O Court Order Date Filedtoun: From To' 0 Other. K Attached: 1111111 11 1 11 Date 111101111111111 1111111 111 11 For Issuing Office Only —to 8k Fee_ Cd Fee. E
tate's responsibility to protect U.S. citizens and non•citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State•05. Overseas Citizen Services Records and State-26. Passport Records. DISCLOSURE: Providing your Social Security number and the other
UING OFFICE ONLY El PPT BK CORO PPT BK SIR 0 PPT CD C/R 0 PPT CD SfR O Marriage Certificate Date of MarriagelPiace Issued: O Cowl Order Date Filedtoun: From Toe 0 Other O Attached: 1111111 11111 Date 111101111111111 1111111 111 11 For Issuing Office Only —le Bk Fee Cd Fee EF Po
Entities connected to both System of Records and Filedtoun

Jeffrey Epstein
PERSONLeon Black
PERSON
Philadelphia
LOCATIONDarren Indyke
PERSON
the Internal Revenue Service
ORGANIZATIONU.S. Embassy
ORGANIZATIONJane Doe
PERSON
Birth
PERSONINTERNATIONAL AIR TRAVEL
ORGANIZATIONPassport Services
ORGANIZATIONOVFRNIGHT
ORGANIZATIONNational Passport Processing Center
ORGANIZATIONPassoon Services
ORGANIZATIONSTATE DEPARTMENT FACILITY
ORGANIZATIONthe Federal Claims Collection Standards
ORGANIZATIONOverseas Citizen Services Records
ORGANIZATIONPassport Records
ORGANIZATIONOffice of Program Management and Operational Support
ORGANIZATIONU.S. PASSPORT RENEWAL APPLICATION
ORGANIZATION
BERMUDA
ORGANIZATION