Epstein Secrets

ly crossing out the incorrect information and writing the correct information above I V ) Wei trio code) o/yei L Alai /J4'// el ,,,yi, !rm....GM:MRCSS (noose mammy/ name, Oa no) (0,4 (axe) ('I code) (I) SOCIAL SECURITY NO. (a) HOME TELEPHONE NO (9) SEX (10)RACEJETHNICOR.GIN (44444.49 01

ns taken against him/her. 0 The student has arrested resulting in a charge. (30) STUDENT LIVES WITH: (check one) 0 Mother 0 Father 0 Both Parents 0 Foster 0 Group Home (31) CUSTODY STATUS OF STUDENT (aeck tee) 0 Mother 0 Father 0 Shared Custody E Other • Other CRS: SEC:OO1 BLDG:O3 RM:212 O6 11 O4 IMPORTANT

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actions taken against him/her. DI The student has wrested resulting in a charge. (30) STUDENT LIVES WITH: (chock ro D Mother 0 Father oth Parents 0 Foster 0 Group Home 0 Other ' (31) CUSTODY STATUS OF S7111:Off (check one) 0 Mother K Father 0 Shared Custody 0 Other IMPORTANT INFORMATION - MUST BE COMPLETED t

SHOULD SE AWARE OF, PLEASE LIST YOUR:.CIELDAENANIOINER latitEACH4gOUNTMSCHOOILSWSVSEKS•M-r: Sig,(4.:?ofp:n:w, ',/4M<Iti .;:fgft.tMita•c)fl . we4 (GM MAYEISI OF OAD0CNI (CS) SCHOOL ATTENDING (7C) STUDENT NO. (OPTIONAL) (711 GRADE O21 BIRTH DATE EFTA01710376 4 .14 - OOL Di's, \ 41 VERIFICATI

hool. • The student has III The student has arrested resulting In a charge. (30) STUDENT LIVES WITH (check one) 0 Mother 0 Father 0 Both Parents 0 Foster 0 Group Home 0 Other (31) CUSTODY STATUS OF STUDENT (check one) 0 Mother 0 Father 0 Shared Custody 0 Other NBR:O23 STDT: CRS:21O46OO SEC:OO4 BLDG:O2 RM:2