acy Act Regulations (6 C.F.R. §§ 5.21 (d) and 5.21(t)), the undersigned: Name: Social Security Number: Date of Birth: Place of Birth: Address: Jeffraaitein January 20, 1953 Kings County, New York 6100 Red Hook Quarter, B3 St. Thomas, U.S. Virgin Islands 00802 (hereinafter referred to as "Epstein"),