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d threats during Applicant's participation in the investigation and prosecution of criminal charges against suspects/defendants Jeffrey Epstein and Ghislaine Maxwell. Applicant expressed fear of retaliation or revenge by individuals connected to or implicated in the alleged criminal acts of Mr. Epstein and Ms. M
l. Applicant expressed fear of retaliation or revenge by individuals connected to or implicated in the alleged criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious harm by such individuals if she were to be removed from the United States. Form I-914, Supplement El Editi
against suspects/defendants Jeffrey Epstein and Ghislaine Maxwell. Applicant expressed fear of retaliation
in the alleged criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious harm by
3. Date of Binh (dd/mm/yyyy) 4. Gender or Sex 02/21/1985 K Male Female K Other 5. Alien Registration lo• A- Number (A-Number) (if any) 6. U.S. Social Security Number (SSN) (if any) Part 2. Agency Information I. 2. 3. 4. 5. 6. Name of Certifying Agency Federal Bureau of Investigations Name of Cenif
d threats during Applicant's participation in the investigation and prosecution of criminal charges against suspects/defendants Jeffrey Epstein and Ghislaine Maxwell. Applicant expressed fear of retaliation or revenge by individuals connected to or implicated in the alleged criminal acts of Mr. Epstein and Ms. M
l. Applicant expressed fear of retaliation or revenge by individuals connected to or implicated in the alleged criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious harm by such individuals if she were to be removed from the United States. Form 1-914. Supplement B Editio
against suspects/defendants Jeffrey Epstein and Ghislaine Maxwell. Applicant expressed fear of retaliation
in the alleged criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious harm by
ddle Name (if any) Date of Birth (ddirrun/yyyy) 4. Gender or Sex El Male El Female El Other Alien Registration Number (A-Number) (if any) P. A- U.S. Social Security Number (SSN) (if any) .r Part 2. Agency Information 1. Name of Certifying Agency Federal Bureau of Investigations 2. Name of Certifying Offici
s physical presence in the United States for criminal investigation Dear USCIS: cooperated in a federal investigation regarding Jeffrey Epstein and Ghislaine Maxwell. In or about February of 2021, counsel, Erica Dubno, informed our office of intent to depart briefly from the United States solely in connection
l. Applicant expressed fear of retaliation or revenge by individuals connected to or implicated in the alleged criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious harm by such individuals if she were to be removed from the United States. Form 1-914, Supplement B Editio
deral investigation regarding Jeffrey Epstein and Ghislaine Maxwell. In or about February of 2021, counsel,
in the alleged criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious harm by
me (if any) 3. 5. 6. Date of Birth (dd/mm/yyyy) 4. Gender or Sex K Male ❑X Female K Other Alien Registration Number (A-Number) (if any) ► A- U.S. Social Security Number (SSN) (if any) Part 2. Agency Information I. Name of Certifying Agency Federal Bureau of Investigations 2. Namc of Certifying Official
Entities connected to both Ghislaine Maxwell and U.S. Social Security

Jeffrey Epstein
PERSON
United States
LOCATION
Department of Justice
ORGANIZATION
FedEx
ORGANIZATIONLeon Black
PERSONFBI
ORGANIZATION
Joi Ito
PERSON
Maine
LOCATION
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATIONAlbany
LOCATIONNew York Field Office
LOCATION
Slovakia
LOCATION
Birth
PERSONU.S. Citizenship and Immigration Services
ORGANIZATIONUSC 2423(a
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONthe Social Security Administration
ORGANIZATIONDivision/Office of Certifying
ORGANIZATIONDelaration of Law Enforcement
ORGANIZATION