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73-031 (4/11) Page 1 of 4 EFTA01684004 Part 4:,case irifOr.Matiok, •Note: Please complete all Information below. 1. Is the Victim currently in the United State 2. The Victim's current immigration status: 3. Is the Victim requesting Continued Presence based upon a pending civil action under 18 U.S.C. § 1595
t Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Class of Admission at Last Entry into the United States E2 5. Place of Last En into the United States City and State) Form 1-102 10/19/17 N Page 2 of 4 EFTA01684010 Part 4. Statement, Certification, Signature, and Contact Information of the Applicant
er. 3.a. Street Number and Name Preparer's Full Name 3.b. O Apt. K Ste. O Flr. l.a. Preparer's Family Name (Last Name) 3.c. City or Town I.b. Prepares Given Name (First Name) 3.d. State 3.e. ZIP Code 3.1. Province 2. arees Business or Organization Name (if any) 3.g. Postal Code 3.h. Country
73-031 (4/11) Page 1 of 4 EFTA01731219 Part 4:,case irifOr.Matiok, •Note: Please complete all Information below. 1. Is the Victim currently in the United State 2. The Victim's current immigration status: 3. Is the Victim requesting Continued Presence based upon a pending civil action under 18 U.S.C. § 1595
t Name) 3.b. Given Name (First Name) 3.c. Middle Name 4. Class of Admission at Last Entry into the United States E2 5. Place of Last En into the United States City and State) Form 1-102 10/19/17 N Page 2 of 4 EFTA01731225 Part 4. Statement, Certification, Signature, and Contact Information of the Applicant
er. 3.a. Street Number and Name Preparer's Full Name 3.b. O Apt. K Ste. O Flr. l.a. Preparer's Family Name (Last Name) 3.c. City or Town I.b. Prepares Given Name (First Name) 3.d. State 3.e. ZIP Code 3.1. Province 2. arees Business or Organization Name (if any) 3.g. Postal Code 3.h. Country
ENFORCEMENT SENSITIVE ICE Form 73-031 (4/11) Page 1 of 4 EFTA01699758 *Note: Please complete all information below. 1. Is the Victim currently in.the United States? El Yes O No 2. The Victim's current immigration status: In the U.S. on an E-2 Visa 3. is the Victim requesting Continued Presence based upon a pen
her than the Applicant Preparer's Full Name Provide the following information concerning the preparer: 1.a. Preparers Family Name (Last Name) Lb. Prepares Given Name (First Name) 2. Prepares Business or Organization Name Preparer's Mailing Address 3.a. Street Number and Name 3.b. Apt. K Ste. K Fl
Entities connected to both United States and Prepares

Jeffrey Epstein
PERSONFBI
ORGANIZATION
Woody Allen
PERSON
Mao Zedong
PERSON
Homeland Security
ORGANIZATION
Department of Homeland Security
ORGANIZATIONAlbany
LOCATIONthe Social Security Administration
ORGANIZATIONFederal, State
ORGANIZATIONthe United
LOCATIONNew York Field Office
LOCATIONCurren
PERSONU.S. Citizenship and Immigration Services
ORGANIZATIONPreparer
ORGANIZATIONNational Crime Information Center
ORGANIZATIONthe Intelligence Community
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONBoard of Immigration Appeals
ORGANIZATION