years and indicate "26 list all COLIntriPS whlnh have ever issued you • pasport the year of visit ENGLAND,FRANCE,SPAIN,GERMANY, USA RUSSIA,SWEDEN,CZECH REPUBLIC, ;•27. List your wt two ph r ea of work, excludin the currant one GREECE,THAILAND,INDONESIA,CUBA 1.thime EPSTEIN INTERESTS Address 457 MADISON A

len? - 26. List all countries you have visited In the last ten years end Indicate the year of visit ENGLAND,FFtANCE,SPAIN,GERMANY, RUSSIA,S.WEDEN,CZECH REPUBLIC, GREECE,THAILAND,INDONESIA,CUPA "27 - . List your lest two ph roil of work excluding tLNrcuffent 404 1. NOM EPSTEIN INTERESTS Address 457 MADISO

ED KINGDOM Description GOODS 05/10/04 ZIZZI ST ALBANS UNITED KINGDOM Description GOODS/SERVICES 05/11/04 PATRIOT-X CAFE REST. PRAHA 1 CZECH CZECH REPUBLIC RESTAURANT 05/11/04 PATRIOT-X CAFE REST. PRAHA 1 CZECH CZECH REPUBLIC RESTAURANT 05/12/04 PATISSERIE LADUREE, PARIS FRANCE VOUS REMERCIE DE