3
Shared Docs
3
Same-Page
3 / 3
Mentions
d and understood the warning on page one of the instructions to the application form. Applicant's Legal Signature FOR 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 Atta
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
nd understood the warning on page one of the instructions to the application form. X AprAlcant's Legal Signature FOR ISSUING 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
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
d and understood the warning on page one of the instructions to the application form. Applicant% Legal Signature FOR ISSUING 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
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 CORO PPT BK and Filedtoun

Jeffrey Epstein
PERSONLeon Black
PERSON
Philadelphia
LOCATIONDarren Indyke
PERSON
the Internal Revenue Service
ORGANIZATIONU.S. Embassy
ORGANIZATIONJane Doe
PERSON
Birth
PERSONU.S. PASSPORT RENEWAL APPLICATION
ORGANIZATIONPassport Records
ORGANIZATIONOffice of Program Management and Operational Support
ORGANIZATION
BERMUDA
ORGANIZATIONA U.S. PASSPORT ISSUED
ORGANIZATIONTHE TRADITIONAL PASSPORT BOOK
ORGANIZATIONTHE U.S. PASSPORT CARD
ORGANIZATIONINTERNATIONAL AIR TRAVEL
ORGANIZATIONPassport Services
ORGANIZATIONOVFRNIGHT
ORGANIZATIONNational Passport Processing Center
ORGANIZATIONPassoon Services
ORGANIZATION