EFTA00307920.pdf

I0:33216 IIIIIII~IIIIIIIII~IIIIIII 1000000494898 State of New York DMsion of Criminal JUStle• Services ••••••••••• *""SINGLP 120 2 1 SP 0.450 001 Hin dirio IrrIrII . . ..iorriltillirriiirollritIlsollirrfl To: JEFFREY EPSTEIN April 9, 2012 6100 RED HOOK QUARTERS. SUITE B3 Offender ID: 33216 ST THOMAS VI 00802 From: Sex Offender Registry Unit, NYS Division of Criminal Justice Services RE: Annual Address Verification Sex Offender Registry Annual Address Verification Form The Sex Offender Registration Act (SORA) requires you to review, update, and sign this Annual Address Verification Form and mail this form back to the Division of Criminal Justice Services within 10 days from receipt of this form. You must do this whether or not you have reported updated information to parole, probation or a law enforcement agency. If you attend, are enrolled at, reside at, or are employed at any institution of higher education, you must provide that information on this form. You must also report your internet service provider(s), all screen names, all e-mail addresses and all other information listed on the form. If you are a level 2 or 3 sex offender, you must report the name and address of all employers. INSTRUCTIONS: • Review each line of information on this form carefully. • If you find any information that is incorrect or outdated, cross out incorrect or outdated information with a single line. • Enter any corrections or any new/additional information in the blank boxes provided. THIS FORM MUST BE SIGNED AND ALL PAGES RETURNED EVEN IF NONE OF THE INFORMATION HAS CHANGED. FAILURE TO RETURN ALL PAGES OF THIS FORM WITHIN 10 DAYS OF RECEIPT IS A FELONY AND MAY RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST. Please contact the Sex Offender Registry at 518-457-3167 with any questions about this form. OFFENDER INFORMATION' LAST NAME FIRST NAME MIDDLE SSN EPSTEIN JEFFREY EDWARD 090443348 M0" caTedor8 4— here OTHER NAMES EPSTEIN.JEFFREY EDWARD Enter any aliases, nick names or other names used in the following section. Page • 1 • of 8 EFTA00307920  IIIIN ' 1000000494898D"2'6 PHYSICAL ATTRIBUTES BIRTHDATE HEIGHT WEIGHT HAIR EYES GLASSES 01 /20/1953 600 180 Gray Blue Make COMX00e6 <— here SCARS/MARKS/TATTOOS Enter any other scars/marks/tattoos. PRIMARY ADDRESS Primary address is the address where you live most of the time. NUMBER/STREETIAPT CITY 6100 RED HOOK OUARTERS.SUITE 83 ST THOMAS mese Callaris .r...-. 1 ewe STATE ZIP COUNTY COUNTRY VI 00802 US Make cored:ate Phone • at this address: (561)855- 7821 Emer phone 0 correction here--> Name of College I University. Page - 2 of 8 EFTA00307921  ID:33216 UIIIIIIIIIIIIIIIOIIUnOIHIJJ 1000000494898 SECONDARY ADDRESS Secondary Address is the address where you live some of the time. NUMBER/STREET/APT CITY er 7iST ST NEW YORK blike corrections 1 .4.- here STATE ZIP COUNTY COUNTRY NY 100214102 New York Make US cancsons .c.- nem Phone X el this address: Enter phone X correction here —> Name of Gothic, / Unversity: NUMBER/STREET/APT CITY Make Cortenis 2 <....here STATE Z/P COUNTY COUNTRY make m FN Careclions 4— Iwo Phone # at this address: Enter phone # correction here —> Name of Cage i University: NUMBER/STREET/APT CITY 49 ZORRO RANCH RD STANLEY Make caimans 3 C.... here STATE ZIP COUNTY COUNTRY NM Meke 87056 US correCtan <- here Phone a at this address: Enter phone X eforteCIKel here —> Name of College I UnverSity: NUMBER/STREET/APT CITY MX EL X FULLO WAY PALM BEACH Make amain 4 <- here STATE ZIP COUNTY COUNTRY Make FL 33480 US C<CM1OrLS <- here Phone # alibis address: Enter shone # correction here —> Name of College I University: Enter any additional Secondary Address in the following section NUMBER/STREET/APT CITY 1 STATE ZIP COUNTY COUNTRY Enter phone a here —> If the above addle s is on the campuS of a College or Universty.enter as name NUMBER/STREET/APT CITY 2 STATE ZIP COUNTY COUNTRY Enter phOr. II here —> If the above address is on the campus of a College or Universty.enter es name Page - 3 - of 8 EFTA00307922  II I~I~IHIDIIIII®I~IIII ID "216 1000000494898 PO BOX ADDRESS PO Box Address is allowed if mail cannot be delivered to the primary address. PO Box Address must be approved by the Post Master and Law Enforcement. Enter any PO BOX Information in the following section PO BOX CITY T STATE ZIP COUNTY COUNTRY EMPLOYMENT INFORMATION EMPLOYER'S NAME NUMBER/STREET/APT FINANCIAl_ TRUST COMPANY INC. FINANCtAL TRUST COMPANY INC 8100 RED HOOK QUARTERS, SUITE 83 make comedian I <— WO CITY STATE ZIP COUNTY COUNTRY ST THOMAS VI 00802 Make US ocerecians o..- here Name of College / University. En er any additional employment information in the following section EMPLOYER'S NAME NUMBER/STREET/APT i CITY STATE ZIP COUNTY COUNTRY If the above address is on the campus of a College o UnNersittenter its name EMPLOYER'S NAME NUMBER/STREET/APT 2 CITY STATE ZIP COUNTY COUNTRY If the above address is on the Campus of a College o University.enter its name HIGHER EDUCATION INFORMATION Higher education includes any 2 or 4 year colleges or any trade or vocational schools. Enter any additional education information in the following section SCHOOL NAME NUMBER/STREET/APT 1 CM/ STATE ZIP COUNTY COUNTRY Dates of Attendance. Employment or Check ale Enrollment To Date From Date • Enrolled • Employed • Attending SCHOOL NAME NUMBER/STREET/APT 2 CITY STATE ZIP COUNTY COUNTRY Oates of Attendance. Entloyment ar Cho:None EivolineM TO Date From Date a Enrolled • Employed 0 Attending Page - 4 - of 8 EFTA00307923  III IIIRIEN9tI m"21' VEHICLE INFORMATION Information of any vehicle that you own or drive. YEAR MAKE MODEL COLOR LIC PLATE STATE 2010 Chevrolet Suburban Black FBJ8826 NY Make carer-bona e.— NM 2006 Bentley Amage Black V752DSN `I Make =melons .'—here 2000 Chevrolet Suburban Black CHX920 NM Make cam:clams c — acre 2007 Hummer Humber II Black i CPK643 NM •• Mak <— en 2005 Cadillac Escalade Black 0299GT FL Make eaftlekalt e— here 2002 Mercedes-Benz SL500 Black C165SP FL Maki earaCatrcl 4.— here 2010 Chevrolet Suburban Black • TED218 VI Make carecions <-11efe 2005 Cadillac Escalade Black TOJ142 VI Make corrocoons <— here 2004 Chevrolet Suburban Black TDZ342 VI Make ceneetkina C.— here 1999 N491GM NM Make COMX00•11 C-- hers 1974 N909JE FL Make camel= C- here 1968 N90&JE VI Make caimans <— he. 1968 2583TC VI Make <mecum C— Mrs 2008 2907TC VI make carman <— here 1998 3558TC VI Mao mremes 4.— nem 2006 0730TC VI make ena60r4 2007 2909TC VI Make ettraCaera C.— here 2000 1093025 FL Mak* cco•coons <— here 2010 3499TC VI Make cefrectsona 4— here 2006 2908TC VI Make corrections Page - 5 • of 8 <— here nann 07CC,ITO EFTA00307924  III 10:332 WIRER Enter any additional vehicle information in the following section YEAR MAKE MODEL COLOR LIC PLATE STATE DRIVER'S LICENSE INFORMATION DRIVER'S LICENSE NUMBER ISSUING STATE C000000029913 . VI Make wreck:ins e— hem Enter any additional driver's license information in the following section DRIVER'S ISSUING STATE LICENSE NUMBER INTERNET INFORMATION SERVICE PROVIDER SERVICE PROVIDER AT&T Make °erten:es .e— hero FREE Make ccireckeis ORANGE TELECOM moo canteens <— here COMCAST Make correctiens <— WO SPRINT Make arm-bons TIME WARNER Make Credal' C••• heft FACEBOOK Make wrececets C-- here Page • 6 - of 6 EFTA00307925  I1111111 11111 O:33216 111111111 1000003494898 SCREEN NAME SCREEN NAME THEJEFFREYEPSTEINFOUNDATION Meld coreCbOns <— here JEFFREYEPSTEIN Make ccereclicns <— her* EMAIL ADDRESS E-MAIL ADDRESS Maio JEEPROJECT@YAHOO COM correcbons <— here Make JEEVACATIONOPME COM =Marone <— here Make gEVACATIDtleriMAILCOM catectons <— here Make SEFRFYFPSTFINORG&GMAIL COM arrOCI,OnS <— here Make [email protected] carectons c.— here Mike if FPROJECT©YAHOO COM corrections v.— here Make IFFVAPATIONi@WIECOM CareCtaIS <— here Enter any additional Internet information in the following section SERVICE PROVIDER SCREEN NAME E-MAIL ADDRESS 8 EFTA00307926  ID:33216 1000000494898 I CERTIFY THAT THE INFORMATION ON THIS FORM IS COMPLETE AND ACCURATE. I HAVE CROSSED OUT ALL INFORMATION THAT IS INCORRECT OR OUTDATED. I HAVE ADDED ALL CORRECTIONS AND ALL NEW INFORMATION. I UNDERSTAND THAT FAILING TO PROVIDE THIS INFORMATION OR PROVIDING FALSE INFORMATION IS A FELONY. Sex Offender's Sex Offender's Date Signature Name(print) THIS FORM MUST BE SIGNED AND ALL PAGES RETURNED EVEN IF NONE OF THE INFORMATION HAS CHANGED. FAILURE TO RETURN ALL PAGES OF THIS FORM WITHIN 10 DAYS OF RECEIPT IS A FELONY AND MAY RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST. Return to: Division of Criminal Justice Services - SOR Page • 8- of 8 EFTA00307927