EFTA00313270.pdf

Registration No: 567563 Person Number: 73274 FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM Agency Name: Palm Beach County SO "*" Note: Your next ReRegistration month is January of 2014'"" Registration For: July 2013 •SEXUAL OFFENDER Reason For Registration O Initial Registration O Scheduled ReRegistration O information Update O Early/Late ReRegistration Registrant Information Name: JEFFREY E EPSTEIN •SSN: DOB: (Firm Mdd'e Last. Soho) Race: White Sex: Male 'Disclosure of your Social Security Number (SSN) is mandatory pursuant CO Florida law. sections 775.21. 943.0435, 944.607. Eratellt. F.S., and federal Ism 42 USC 16901, seq. Use of your SSN is for the papaws or deadhead:et FDLE may share the infon'mtion with the other ireenciss for the same outpost. FL DL or ID Card #: Height: 6' 00 • Weight. 180 lbs Hair. Grey Eyes: Blue Place of Birth: United States Of America (use) Currently on ProbalionParole: 0 No O Yes Probation Type: O State Officer Name: Phone: ( ) State O Federal Officer Name: Phone: ( ) City O County Officer Name: Phone: ( ) County Out of State Travel Information (Complete if permanent, temporary, or transient address is out of state) O Permanently leaving Florida to establish a residence In another state Date of Departure: O Temporarily leaving Florida to visit another state O Moving from another state to permanently establish a residence In Florida Date of Arrivat O Visiting from another state and establishing a temporary address in Florida El Other (please describe): Mr. Epstein came in to do his scheduled registration and wil be leaving going back to his permanent address tomorrow 07/21Mt3. Previous Permanent Address Current Permanent Address 6100 Red Hook Quarters Ste B3 (Address Une 1) (Address Line 1) Little St James Islands (Address Une 2) (Address Line 2) St Thomas VI 00802 (City) (State) (DP) (City) (Slate) Rim County: End Deis: County: St Thomas Stan Date: 07/1912010 I do NOT have a permanent address at this time. Pees I of 6 201247-25 34028 PM EFTA00313270  Registration No: 567563 Person Number: 73274 Temporary Addresses 0 I de NOT have • temporary address Please note: The registrant has reported additions' temporary addresses not displayed here. 1. 356 El Grillo Way Palm Beach FL 33480-4730 (Street Address) (City) ' (Slaw) Rip) County: Palm Beach Dates you will be at this add/ass From: 07126/2012 To: 2. 9 E 71st St New York NY 10021-4102 (Street Address) (City) ' r( e) (734/7) County New York Dales you will be at this address: From: To: 3. (Street Address) (City) (State) (Zip) County Dates you will be at this address: From: To: Transient Addresses 0 I do NOT have • transient address 1. (Street Address or location) (City) (Stale) (Zip) ' County: Dates you will be at this address: From: To: 2. (Street Address or location) (City) (State) Rio County: Dates you will be at this address: From: To: 3. (Street Address or location) (City) (State) (20) County: Dates you will be at this address: From To: Employment Want currently unemployed. 1. Employer. Financial Trust Company Occupation: Owner Start Date: 07/26/2012 Address: 6100 Red Hook Quarter Ste 83 St Thomas VI 00802 (Street Address) (qty) i (Stale) (re) County: Saint Thomas Contact Person: 2. Employer Occupation: Start Date: Address: (Street Address) (OM i (Stew) (Dal County: Contact Person: 3. Employer Occupation: Start Date: Address: (Street Address) (City) (State) (2e) County: Contact Person: Page 2 d6 20110745 3-4(t.28 Phi EFTA00313271  Registration No: 567563 Person Number: 73274 Mailing Address Please note The registrant has reported additional Phone Numbers phones not displayed here O Same as Permanent O Same as Temporary O I do NOT have or use any home or mobile phone numbers 9 E 71st St Phone Number: Phone Type: (Ackkess Line 1) 1. Horne (Address Lie 2) 2. Mobile New York NY 10021 3. Fax (Clly) (Slato) (29) 4. _ Work County: New York End Dew 5. Fax Vehicles ❑ I do NOT own or use a vehicle, RV, trailer or mobile home. Please note, The registrant has repelled additional vehicles not displayed here 1. 2013 Ford Expedition Black Truck (Year) (Make) (model) (C.okir/Color Scheme) (Vehicle Typo) NM This vehicle is: ID NOT used as a residence O Used as a residence (License Tag JO (Slate) 2. 2013 Dodge Caravan Black Auto (Year) (Make) (Model) (Color/Color Scheme) (Vehicle Type) VI This vehicle is: O NOT used as a residence a Used as a residence (License Tee 10) (State) 3. 2008 Land Rover Range Rover Black Truck (Year) (Make) (Mode) (Color/Color Scheme) (Vehlde Type) NM This vehicle Is: a NOT used as a residence O Used as a residence (License Tag //) (State) 4. 2012 Cadillac Other Black Truck (Year) (Make) (Model) (Color/Color Scheme) (Vehicle Type) NY This vehicle is O NOT used as a residence O Used as a residence (license Tag N) (State) Vessels DIdo NOT own a vessel or houseboat. Please nobs: The registrant has reported additional vessels not displayed hens 1. 1968 Other White Big N (Year) (Vessel Type) (Cora/Color Scheme) (Name of Vessel) Yes This vessel is rac NOT used as a residence O Used as a residence (Registration I) 2. 2011 Other White (Year) (Vessel Type) (ColoaCeior Scheme) (Name of Vessel) Yes This vessel is: M NOT used as a residence O Used as a residence (Registraoon 5) 3. 2011 Other White (Year) (Vessel Type) (Color/Coke Scheme) (Name of Vessel) This vessel is: 0% NOT used as a residence Used as a residence yea Ell (Recirmition a) 4. 1999 Other White Nana (Year) (Vessel Type) (Co/or/Color Scheme) (Name olVesalil) 788 This vessel IS 0x NOT used es a residence O Used as a residence (Registration l/) Page 3 of V13-07.2631414e28 PM EFTA00313272  Registration No: 567563 Person Number: 73274 Campus Activity E I am NOT s student employee, or volunteer at a university or institution of higher learning. 1. D Student O Employee ❑ v„,„n,cor Slag Date Erd Date University/School Name' Campus. Address: (Street Address) (City) (State) (Zip) County: Employer. Contact: 2. MI Student O Employee O Voiumeer Start Date: End Date: University/School Name: Campus: Address (Street Address) (City) (Zip) (Stale) County Employer Contact: 3. ❑ Student O E mph:not O Volunteer Start Date: End Date: University/School Name. Campus: Address. (Street Address) (City) . (State) (10) County Employer. Contact: Cyber Communication Accounts ❑ I do NOT use any email addr or Instant blesses • screen names. Please rote The registrant has repont.4 additional online accounts not displayed hem Email Addresses metantftessage Screen Names Name: Provider. 1. 1. 2. 2. 3. 3. 4. jeeprMett@yah0o corn 4. 5. 5. Adjudication Information Date Adjudicated Crime Location of Adjudication/Conviction Victim Information 1. O Minor O Adult Gender (County) ' (Stale) 2. . O mina O Adult Gender. (County) (State) 3. O Minor O mull Gender: (County) (State) 4. O moor O Adult Gender: (County) (State) Were you or ere you subject to registration or community notification in another state? CI yes 0 No If Yes. in what state? Page 4 of 6 2013-0?-25 3.40-M PM EFTA00313273  Registration No: 567563 Person Number: 73274 NOTICE OF SEXUAL PREDATOR AND SEXUAL OFFENDER OBLIGATIONS As a sexual predator (F.S. 775.21) or sexual offender (F.S. 943.0435; 944.607; or 985.4815) I understand that I am required by law to abide by the following: "Permanent residence" means a place where the person abides, lodges, or resides for 5 or more consecutive days. "Temporary residence" means a place where the person abides, lodges, or resides, including but not limited to, vacation, business, or personal travel destinations in or out of this state, for a period of 5 or more days in the aggregate during any calendar year and which is not the person's permanent address or, for a person whose permanent residence is not in this state, a place where the person is employed, practices a vocation, or is enrolled as a student for any period of time in this state. "Transient residence" means a place or county where a person lives, remains, or is located for a period of 5 or more days in the aggregate during a calendar year and which is not the person's permanent or temporary address. The term includes, but is not limited to, a place where the person sleeps or seeks shelter and a location that has no specific street address. FAILURE TO COMPLY WITH ANY OF THE FOLLOWING REQUIREMENTS IS A FELONY OF THE THIRD DEGREE (UNLESS OTHERWISE NOTED). 1. I MUST report Mignon to the local Sheriffs Office within 48 hours of establishing or maintaining a residence in this state, within 48 hours of release from custody and/or supervision of the Department of Corrections (DOC), the Department of Children and Family Services (DCFS), or the Department of Juvenile Justice (DJJ), or in the county of conviction within 48 hours of conviction if not under custody and/or supervision of DOC to register my temporary, transient, or permanent address and other information specified in statute. {F.S. 943.0435(2)(a); 775.21(6)(e)11. 2. At initial registration, I MUST provide the following information to the department: name, date of birth, social security number, race, sex, height, weight, hair and eye color, photograph, home telephone number and any cellular telephone number, any electronic mail address and any instant message name required to be provided pursuant to paragraph s. 943.0435(4)(d) F.S. or s. 775.21(6)(g)4 F.S., address of legal residence, address of any current temporary residence, if no permanent or temporary residence, any transient residence within the state, dates of any current or known future temporary residence within the state or out of state, occupation and place of employment, date and place of each conviction, fingerprints, and a brief description of the crime or crimes committed. (F.S. 943.0435(2)(b); 775.21(6)(a)11. 3. Within 48 hours after the initial report required as stated in requirement #2 above, I MUST report in person to the driver's license office of the Department of Highway Safety and Motor Vehicles (DHSMV) and provide proof of initial registration as a sexual offender or predator to secure or renew a valid Florida driver's license or identification card displaying one of the following designations: "775.21, F.S." or "943.0435, F.S.", unless a driver's license or identification card with such designation was previously secured or updated. The sexual offender shall submit to the taking of a photograph for use by the department in maintaining current records of sexual offenders/predators. (F.S. 943.0435(3); 775 .21(6)(0). 4. Each time my driver's license or identification card is subject to renewal, or within 48 hours after any change in my permanent, temporary, or transient residence or change in name made by marriage or other legal process, I MUST report in person to a driver's license office to update my driver's license or identification card and ensure that the driver's license or identification card displays the designations as identified in requirement #3. (F.S. 943.0435(4)(a); 775.21(6)(9)1}. 5. If I am enrolled, employed or carrying on a vocation at an institution of higher education in Florida, I MUST provide the name, address and county of each institution including each campus, enrollment or employment status, including each change in enrollment or employment status, i.e. commencement or termination, In person at the Sheriffs Office; OR, for a sexual offender on supervision with the Florida DOC or DJJ, this information must be reported to the sexual offenders probation officer, within 48 hours after any change in status. (F.S. 943.0435(2)(b)2; 775.21(6)(a)1.b}. 6. I MUST report any electronic mail address or instant message name, prior to using such, during registration/ reregistration or by providing all updates through the online system maintained by the Florida Department of Law Enforcement. {F.S. 943.0435(4)(d); 775.21(6)(9)4). 7. If I vacate a permanent, temporary, or transient residence, and do not have another permanent, temporary, or transient residence, I MUST report Ingerson to the Sheriffs Office in the county where I am located within 48 hours. {F.S. 943.0435(4) (b); 775.21(6)(g)2}. 8. If I report that I have vacated a permanent, temporary, or transient residence and then remain at that residence, I MUST report in person to the Sheriff's Office where I reported vacating my residence. Failure to report this information is a felony of the second degree. {F.S. 943.0435(4Xc); 775.21(6)(g)3}. Per 5 of6 2klari,13:1428.111 EFTA00313274  Registration No: 567563 Person Number: 73274 9. I understand that my address will be verified by county, state or local law enforcement agencies. {F.S. 775.21(8)}. 943.0435(6); 10. If I intend on establishing a permanent, temporary, or transient residence in another state or jurisdiction other of Florida, I MUST report in person to the Sheriffs Office in than the State the county of my current residence within 48 hours date that I intend to leave this state to establish reside before the nce in another state or jurisdiction. {F.S. 943.0435(7); 775.21(6)(0). 11. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other of Florida and later decide to remain in this state, I MUST than the State report in person to the Sheriffs Office to which I report my intention of leaving the state within 48 hours after ed the intended departure date. Failure to report this felony in the second degree. {F.S. 943.0435(8); 775.21(6)(j)}. information is a 12. I MUST report imams either twice a year (durin g the month of my birth and during the 6th month followi month) or four times &year (once during the month ng my birth of my birth and every 3rd month thereafter), depending offense/designation, to the Sheriffs Office in the county upon my in which I reside or am otherwise located to reregister, otherwise notified by FDLE. unless All sexual predators, sexual offenders convicted for offenses specified in F.S 943.0435(14)(b), andjuvenile sexual offenders required to register per F.S 943.0435(1)(a)1.d are required to reregister four times a year. All other sexual offend ers are required to reregister twice a year. El AM REQUIRED TO REREGISTER n I AM REQUIRED TO REREGISTER FOLIg TIMES A TWO TIMES A YEAR; I MUST YEAR; I MUST REREGISTER AS NOTED BELOW. REREGISTER AS NOTED BELOW. (Pursuant to Sections 943.0435(14)(a), {Pursuant to Sections 775.21(8)(a), 943.0435(14)(b), 944.607(13)(a), Florida Statutes} 944.607(13)(b), 985.4815 13)(a), Florida Statutes) Month I must Month I must Month I must reregister Month I must reregister of Birth reregister in: of Birth reregister in: of Birth In the months of: of Birth in the months of: Jan Jan & July July Jan & July Jan Jan, April, July & Oct July Jan, April, July & Oct Feb Feb & Aug Aug Feb & Aug Feb Feb. May, Aug. & Nov Aug Feb, May, Aug. & Nov Mar Mar & Sept Sept Mar & Sept Mar Mar, June, Sept & Dec Sept Mar, June, Sept & Dec April April & Oct Oct April & Oct April April, July, Oct & Jan Oct April. July, Oct & Jan May May & Nov Nov May & Nov May May. Aug, Nov & Feb Nov May, Aug, Nov & Feb June June & Dec Dec June & Dec June June, Sept, Dec & Mar Dec June, Sept, Dec & Mar 13. If I live in another sta e, but work or attend schoo l in Florida, I MUST register my work or school addres address within 48 hours by reporting in oerson to the s as a temporary local Sheriffs Office. {F.S. 943.0435(2); 775.21(6)(a)1 (e)1}. b; 775.21(6) 14. 1 MUST respond to any address verification corres pondence from FDLE within three weeks of the correspondence. (F.S. 943.0435(14)(c)4; 775.21(10Xa date of the )}. 15. If I am employed, carry on a vocation, am a studen t, or become a resident of another state, I am on notice a requirement to register under the laws of that state. that I may have 16. I MUST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(1)). PLEASE READ CAREFULLY REFORE SIGNING As a sexual predator (Florida Statute 775.21) or sexual offende r (Florida Statute 943.0435, 944.607, or 985.4815), I am required by law to abide by the requirements listed on this form. BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ OR HAVE BEEN READ THE REQUIREMENTS ON THIS FORM, AND THAT I UNDERSTAND THESE REQUIREMENTS. Under penalty of perjury I declare the above is true and correct. YOU ARE REQUIRED 0 REREGISTER EACH YEAR AT THE SHERIFFS OFFICE IN T THS OF January AND July. Registrant: Witnessed by Reporting Officer. Printed Name: JEFFREY E Signature Required Date: 07/292013 Printed Name: Shenica Date: 07125/2013 • OFFICIAL DOCUMENT DO NOT DESTROY' ••••' NOTE: Your next ReRegIstratIon month Is Janua ry of 2014. ""• Page 6 of 6 2013-07-25 140.29 Pod EFTA00313275