Epstein Secrets

,,43 D. Race ElWhite Asp or Pacific Islander D Black Amencan Indian or Alaskan Native E. Hair color

st Name) Given Name (First Name) Full Middle Name (/lappheable) 2. Date of Birth (Month/Day/Year) and Name 3. Date of Mamap (Month/Day/Year) 4. Spouse's Social Security Number / 5. Nome Address - Street Number Apartment Number City State ZIP Code 1 SDNY GM 00000722 runs N.4007Rev—OX3 I/01)N

ect all applicable boxes) K White K Asian K Black or African K American Indian American or Ala

e. K Yes K No A. B. C. D. Current Spouse's Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Current Spouse's Previous Legal Name Family Name (Last Name) Given Name (First Name) Middle Name (if applicable) Other Names Used by Current Spouse (include nic

BLOOMINGDALE'S Description Prke RALPH LAUREN BLACK $398.00 $243.29 09/10/12 JUICE ON THIRD INC N

d Person means the Basic Cardmember, each Additional Cardmember, and each of these Cardmember's spouses or Domestic Partners and dependent children. Spouse includes the person to whom you are married, including your same-sex partner in your marriage that was legally performed in another jurisdiction. De

Not Returned O Reopen Account CI Remove Reissue Black O Add Stephan* Number Area Code Mena Mote O Na

Fiequest .,rear; 1:2. Business Name V es LI- FOR MARITAL PROPERTY STATES ONLY O Married O Not Married O Legally Separated Name and Address of Spouse ACCOUNT RECORD CHANGES O Close Acct O Add Soc. Sec. No. _ - ____• _- O Cards Returned O Cards Not Returned O Reopen Account O Remove Reissue Blo