Epstein Secrets

ctory Information X X X Miscellaneous Race: Black or African American Race: American Indian or A

7/19/2021 Student Info L 128/0606 - Grade 10 t Demographics Local Student ID Legal Name L Suffix Nickname Former or Maiden Name Birthdate 08/09/1983 Location of Birth SACRAMENTO.CA Country of Birth US - United States Birth Date Verification 1- Certified Copy of Birth C

CTIONS PERSONAL IDENTIFICATION L INFORM/G:0N IN BLACK LAS NAM FIRST NAME MIDDLE MME FIN LEAVE BLA

rst Name Middle Name authorization from USCIS? K Yes (Complete the following questions.) Which USCIS Office? Dates 2. Other Names Used (include Maiden Name) Family Name First Name Middle Name Results (Granted or Denied - attach all documentation) K No (Proceed to Question 12.) 3. U.S. Mailing Addre

address and telephone number of destination: Roy Black 305-371-6422 201 S Biscayne Blvd. Miami, FL 3313

tate Zip Home Phone and Cod # Significant Other. Name Relationship Phone* Next of Kin/SignificaM Other: Street Address: City State Mother's/ Maiden Name: .C.ro I. 0 clew, Mother's and/or Father's Street Address: City State Mother or Fathers phone number, including area COO,: Employer's Name (Pri