EFTA00316219.pdf

U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS .C-:.;noccpr.RTRAcA. Tozolff u 40-0220 1,31 • Please Print Legibly Using Black Ink Only shy-won Ream R so MN Attention: Read WARNING on page tor instructions Please select the documont(s) for which you are applying: [g] U.S. Passport Book 0 U.S. Passport Card 0 Both Thein primal tard us .addle olernallOs0Id IMO rot mode Wousiken US W, I er reaturn E1211Page Book (Standard) O 52 Page Book (Non-Slairtlard) mg: 'yew woo awn is ear wow ranmoony YAW. samara* leo rassecni.vsyparta and a usaanaurd tor wolcanis Ws rOft 00.4:464/ WNW TO PONOti 04,44 PONS 1. Name Last DP DOTS Code EPSTEIN End It ExP First Middle JEFFREY EDWARD 2. Date of Birth gmelddlyyyy) 3. Sex 4. Place of Birth (City& State ifintim U.S.. or City & Courary.ss it is prosentty known) M F 01 20 1953 X NEW YORK, NY at S. Social Security Number 8. Email Address to i; ft,/ emagratiomme COM) 7. Primary Contact Phone Number JEEVACATION@GMAIL . COM 8. Malting Box. or URB. 6100 RED HOOK QUARTER, B3 AddreSS Line 2: Clearly label Apartment. Company. Sul*. Unit. Budding. Floor. In Care Of or Morison if appkable. (e.g. In Care Of - Jane Ooe. Apt d 100) City State Zip Code Country. d outside the Unted Stales ST TRONAS VI 00802 9. List other names you have tried. (Examples BIM Name. Malden. PlevioriS Marriage. Legal NMI*? Change Ailed) ackbtional pages /t needed) A B 10. Passport Book andior Passport Card Information---- Your name as printed on your most recent U.S. passport book and/or passport card ta 71N f. / ..A: -.\ $ ce nt JEFFREY EDWARD EPSTEIN Most recent passport book number Issue date 0nmildlyyyy) I I a ' 516923892 06/30/2014 x most recen: passport card number Issuc date (rmatilyny) iX •' +j 1) 4 11. Name Change Information Complete d twine is clement than Iasi U.S. passport book or passpon card Opal 90V toy hunotiv Place of Name Change (City/Slalo) Date 0nin/ddlywy) 1- 69 Changed try Cowl Order A°1111W&MTMVr Please subio4 a berthed cony (Photocopies are not aCCepted!) CONTINUE TO PAGE 2 YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW I declare under Orally o! PeborY all Of the lollOiving 1) I Ont a OU204 a nonotiren 111114511211 Of Ihe United SEcs DES nine nOt. soiree acosai ea U S ol.zenfr.0 or nasanaLly Performed any of the ad; fUted Luau-Ms or Coultio=-orl Papa tor of fie insbuCteet ofIn Otra wilco {,tnsr rodwnvory WienTent K or:ached/. re Statements rondo co trio tioiscrinn as mie and coma 31 1 nave no km...ivy end ndhnlly made two staserreinls Or inCloCOd t1'30 OCICUMentS In support ol act app als:xi 5):-. phwcorapi stashed ?nth !WS appliadion n a punume ornent poioutomplt or at and a) iliam read and irecler=odasevitimlng on page one of toe inStruCtaa the accOcaaon tan x appricarrs Legal &outwit FOR ISSUING OFFICE ONLY . PPT OK CM OPT gl< Sil PPT CD OR L PAT CO SP O Manage CenifiCrY.0 On of Moulage/Oboe Issued U COWS Oiciei Date F ilea:Court Poem To. Other Attatred For Issuing 0ffre only CO Fee FF Postage OWel all DR.-S2 01.2012 Paao1of 2 EFTA00316219  Name of Applicant (Last Fist 45 Peddle) Date of Birth ihrhYdcYyyyy) EPSTEIN, JEFFREY EDWARD 01/20/1953 12 Height 13. Hair Color 14. Eye Color 1$. Occupation 16. Employer or School hiappEcabig Sft. Ilia. GRAY BLUE BANKER SOUTHERN TRUST COMPANY 17. Additional Contact Phone Numbers Ng, ev COI /Inv Oita. 'Ph* It Permanent Address: IfP O. Box is listed under Mailing Address zit residence is different from Maiing Address. Street/RFD* or URB (No P.O. Box) Apartinentillra Stale Zip Code IS. Emergency Contact • Provide the informs Pion ofa person not traveling mlh you to to contacted in the *tent ofan emergency NM* Address SucebRFD a or P.O. Box Aparenenteine DARREN INDYKE C1y State Zp Code Pho00 Number Rnlationthp ATTORNEY 20. Travel Plans Departure Date (mmtddlyyyy) Return Date PruniddsYYYY) COuntnes to be visited STOP! YOU HAVE COMPLETED YOUR APPLICATION BE SURE TO SIGN AND DATE PAGE ONE DS 82 08 2013 Pao 2 of 2 EFTA00316220  GO TO RUSSIA 877-898-1203 Letter of Authorization Please carefully read the information below before completing this Letter of Authorization. An individual's personal information cannot be released by the U.S. government to another party without the written consent of the individual under the provisions of the Privacy Act of 1974 (5 USC 552a). As a result, an employee at a U.S. passport agency cannot discuss the details of your passport application with a third party without your written consent. Please check all that apply: / I authorize the company stated below to submit my passport application to a passport agency and pick up the passport from a U.S. passport agency on my behalf. authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that that may arise in connection with my passport application, and 1 authorize the company to respond to such requests under my direction. 0 I do not authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that may arise with my passport application. I want the passport agency to contact me directly should an issue arise with my passport application that concerns matters other than the date on which the passport will be ready for pick-up from the passport agency. Applicant Information (Note: All of the information below may ONLY be filled out by the applicant, parent, legal guardian, or person legally acting in loco parentis) Applicant Name: CMIE : 711Q 3EFT2a Fuerne__ (Last Name, First Name, Middle Name) Applicant Phone No: Date: 05-a5 xDKo (MM/DD/YYYY) Courier Company Name: 60 IT) (L - ISS /A Applicant Signature: (If the applicant is under the age of 16, a parent, legal guardian, or person legally acting in loco parentis must sign) EFTA00316221  GO TO RUSSIA 877-898-1203 Letter of Authorization Please carefully read the information below before completing this Letter of Authorization. An individual's personal information cannot be released by the U.S. government to another party without the written consent of the individual under the provisions of the Privacy Act of 1974 (5 USC 552a). As a result, an employee at a U.S. passport agency cannot discuss the details of your passport application with a third party without your written consent. Please check all that apply: 61.7I authorize the company stated below to submit my passport application to a passport agency and pick up the passport from a U.S. passport agency on my behalf. /authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that that may arise in connection with my passport application. and I authorize the company to respond to such requests under my direction. 0 I do not authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that may arise with my passport application. I want the passport agency to contact me directly should an issue arise with my passport application that concerns matters other than the date on which the passport will be ready for pick-up from the passport agency. Applicant Information (Note: All of the information below may ONLY be filled out by the applicant, parent, legal guardian, or person legally acting in loco parentis) Applicant Name: EPSTF.1 NJ , (Last Name, First Name, Middle Name) ENA)ote Applicant Phone No: Date: 05 —a5 - 001(o AA (MM/DD/YYYY) Courier Company Name: GO 10 Applicant Signature: (If the applicant is under the age of 16, a parent, legal guardian, or person legally acting in loco parentis must sign) EFTA00316222  G3 VISAS & PASSPORTS Tel. 888.883.8472 Letter of Authorization Please carefully read the information below before completing this Letter of Authorization. An individual's personal information cannot be released by the U.S. government to another party without the written consent of the individual under the provisions of the Privacy Act of 1974 (5 USC 552a). As a result, an employee at a U.S. passport agency cannot discuss the details of your passport application with a third party without your written consent. Please check all that apply: gl/ I authorize the company stated below to submit my passport application to a passport agency and pick up the passport from a U.S. passport agency on my behalf. 07 1 authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that that may arise in connection with my passport application, and I authorize the company to respond to such requests under my direction. O I do not authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that may arise with my passport application. I want the passport agency to contact me directly should an issue arise with my passport application that concerns matters other than the date on which the passport will be ready for pick-up from the passport agency. Applicant Information (Note: All of the information below may ONLY be filled out by the applicant, parent, legal guardian, or person legally acting in loco parentis) Applicant Name: EMTRIK)751FiWq risuoPeD (Last Name, First Name, Middle Name) Applicant Phone No: Date: 05-Q5-cDoi (Area Code-XXX-XXXX) (MM/DD/YYYY) Courier Company Name: C,I5 kIISPS ¶ PASS1)012.TS Applicant Signature: (If the applicant is under the age of 16, a parent, legal guardian, or person legally acting in loco parentis must sign) EFTA00316223  G3 VISAS& PASSPORTS Tel. 888.883.8472 Letter of Authorization Please carefully read the information below before completing this Letter of Authorization. An individual's personal information cannot be released by the U.S. government to another party without the written consent of the individual under the provisions of the Privacy Act of 1974 (5 I/5C 552a). As a result, an employee at a U.S. passport agency cannot discuss the details of your passport application with a third party without your written consent. Please check all that apply: V I authorize the company stated below to submit my passport application to a passport agency and pick up the passport from a U.S. passport agency on my behalf. /1 authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that that may arise in connection with my passport application, and I authorize the company to respond to such requests under my direction. 0 I do not authorize the passport agency to disclose to the company listed below any requests for further documentation and/or information that may arise with my passport application. I want the passport agency to contact me directly should an issue arise with my passport application that concerns matters other than the date on which the passport will be ready for pick-up from the passport agency. Applicant Information (Note: All of the information below may ONLY be filled out by the applicant, parent, legal guardian, or person legally act ng in loco parentis) Applicant Name: 30:-F2Eq EN)OPta (Last Name, First Name, Middle Name) / Applicant Phone No: Date: CF)—r-D5 (Area Code-XXX-XXXX) (MM/DD/YYYY) Courier Company Name: C---)3 i Pplsspoets Applicant Signature: (If the applicant is under the age of 16, a parent, legal guardian, or person legally acting in loco parentis must sign) EFTA00316224  United States Department of State TO: U.S. Department of State San Francisco Passport Agency RE: Request for issuance of a second 2 year passport I, the undersigned, am the bearer of valid U.S. passport number 51toga20 21c; issued on The 724D,J;ok (number) (date) In view of the restrictive entry policies of one of the countries that I will be visiting, or prolonged processing delays required to obtain visas for my current travel, it is impossible for me to complete my trip utilizing my current passport. Consequently, I am requesting the issuance of a second passport to facilitate my travel to the countries provided on my passport application. I understand that one .passport will be _limited for two years and that I may reapply at the end of that period if my need to travel to the aforementioned countries continues. Should either passport be lost or stolen, I will report the circumstances immediately to the Passport Office or the nearest U.S. Embassy/Consulate. NAME: Tecfreq Fp-4e kn (Please Print.Name Legibly) SIGNATURE: DATE: -7:35 I CD EFTA00316225 Hrnll 1.3 (12. C;tritt At hy: 3ort let 38e. t • :en, :r. SAN FRANCISCO Sinn it: SECOND VALID PASSPORT Payment Information :X COItier Ca() Ser vide Pa trtueiltert laZtilasni0: 5 4 7 4 ' I 5 I 3 7 3 0 8- 2 5 6 Exp. Date I r r 19 Secunty Code: 3 5 7 OR American Express Exp Date I Seemly Code: FEE r Traveled TOTAL Name as it appears On The Md. Darren K. Indyke COTTON:0e Fee $175.00 X = $175.00 US Cominnoril Foe Si it oo X SI10.00 Riling Address- 63Service Fee $275.00 X — $275.00 ay. NV Stale NY Zip: 10022 Passport ProlactionPlri $40.00 X = Sii0.110 Return Ornery fee 55.00 Signature: Subtotal 5665.00 Add 5% for credit awl canyon:we lee 537.20 53 Customer Wetter. Baling. P.O.. Project or Reference Codes: Total Payment Enclosed $702.20 ; raveler I. • • Traveler 1 Nance: Jeffrey Edward Epstein Dated Guth 01/20/1953 Tice ter 2 Mime: Date le Birth Service: le Second Valid Passport Wed< Onhl hussion Critical Poway Expel:tied PliXoxirl9 SOced; Second Valid Passport (Bock and Ean:11 Date of US DePalture: ANTICIPATED 06/. . /2016 must have my passnavl no later than: Dat .2016 Pew visa or passport services requested: notes Game' Darren K. Indyke a/mx1617: Warren K. Indyke. 1-ILLC Contact Email (recoired? Daytime Moon tactil e Phone "'it Darren K. Indyke company. Warren K. Indyke. PLLC Street AdOnno: C'I Y New York NY ZIP ezde: 10022 Darin: Phone: AkiKie I.~1.1.111 EFTA00316226  Sr'nri ;yr 1r..mo t. . ob .,' IS r. F.Z..-vIce•. Atht: cd • i.e.:2t)tl t ;Cll. irt:55,,nl -5.. -:,• .! ..$ 4. .• I! , ./ , , SAN FRANCISCO •...1.61 : V .1 . ‘“) :,,, SECOND VALID PASSPORT Special Services x. Sendege Sete 075.00 ,g Pastan Mimics) Plan $4000 t Covernme.nt Fees for Passport Processing Second Valid Passport (Book Only) x $170.00 Second Valid Passport Book and Passport Card 5200.00 Service Fees Pas.rpat Renewal x S275.00 S195.00 SI IO.E13 FedEx Express Saver FedEx First Overnight* 519.00 584.00 FedEx Standard Overnight FedEx Saturday Deliver/ $44.00 529.00 Same Day Delivery FedEx International Delivery' Please Call including Puerto Rico Please Call FedEx or UPS Account Number Provided FedEx or UPS Return Airbil Included $5.00 No Charge 455692741 Passport Protection Plan x sags so rt in ton:. ;:toter. or dnntoccd. G3 will it:pi:Iced w.thent eltmtpn.; nor -.tantlarcl -....rwce ter • ‘.: • r: unc:, . • tr • L: • '" APaeoation Creation: Our exPortn will (=van. Your mleserwork br you to ensure that it newest the requirements of the =sport agent/. WiovAng you to avoid Ways and addiionar Strm.5. Expedited Passport PrOCOSSillg: YoUl now pan:port WI be roouod at our expedited pa:coral° mood. II claw t. %IX: tiny tevade to:thaw Service by payisg the prize Mount° al the time detain Personal Attention: OW Witt Ce yo r Mamie:S. we will hand-any you dOLVIIIWIStO the passport agency. then pick up you: cornpluted passport and toview it fer aCairaCy Long-Torrn Validity: You,- Passport Protection Plan s in tome tent est day your pat15041 International Support: It Ake Passport is lost. stokers or Oatwaged winks you we ouextio el the US. G3 to weate your passpon appiCaliOTC and pro/de you with scam. of your but =sport so you can have your passport issued in prisms the nearwrt US trstkrisy or Consulate G3's Industry-Loading Standard of SOIVICO: (kir expenur iced slur will povdo poroord communeation and depth knowledge to ease yin mmd and red...15c your cotr..ents Ftwors Mote:dmPc, aka oI war dvdmayenait tab.maim lars. eleItareag N 'JAW Qcbi.' twa,: Attn: Passport Department, 388 Market Street, Suite 1520. San Francisco. CA 94111 415.762.8268 Phone I 877.898.1203 Toll Free ' 415.762.8269 Fax I SanFrarcisco4g3visas.com EFTA00316227  SOUTHERN TRUST COMPANY, INC. 6100 Red Hook Quarter, B3 St. Thomas, USVI 00802 May 25, 2016 U.S. Passport Office Department of State To Whom It May Concern: I am the President of Southern Trust Company, Inc., an international financial firm, and travel internationally with great frequency. As a consequence, my passport is with me when I travel abroad, and I cannot obtain visas for the trips that are planned while I am out of the country, which causes undue hardships and much inconvenience. In addition, on extremely short notice, I am frequently requested to reschedule international trips with itineraries to multiple destinations requiring me to obtain multiple visas at the same time, which is simply not possible on such short notice without a second passport. It was for these reasons that the U.S. Passport Office previously issued me a second passport. However, that second passport will expire on June 29, 2016. I anticipate an extremely rigorous upcoming international travel schedule. In the immediate future, I am scheduled to travel to France on June 13, 2016, and also anticipate travel on June 20, 2016 to for business matters. I will therefore need to obtain visas for these additional countries, and likely others, while traveling with my current passport in my possession, and respectfully request that a second valid U.S. passport again be issued to me. I understand that the passport will onl be valid for a limited period. If you have any questions, please feel free to call me at Should either my original 10-year passport or, if issued, my limited validity (second valid) passport be lost or stolen, I will report the circumstances immediately to the Passport Office in Washington, DC, or, if abroad, to the nearest U.S. Embassy or Consulate. Thank you for your assistance with this matter. Sincerely, Jeffrey Edward Epstein EFTA00316228  DARREN K. INDYKE DARREN K. INDYKE, PLLC May 25, 2016 U.S. Passport Office Department of State To Whom It May Concern: Jeffrey Edward Epstein is the President of Southern Trust Company, Inc., an international financial firm, and travel internationally with great frequency. As a consequence, his passport is with him when he travels abroad, and he cannot obtain visas for the trips that are planned while he is out of the country, which causes undue hardships and much inconvenience. In addition, on extremely short notice, he is frequently requested to schedule international trips with itineraries to multiple destinations requiring him to obtain multiple visas at the same time, which is simply not possible on such short notice without a second passport. It was for these reasons that the U.S. Passport Office previously issued Mr. Epstein a second passport. However, that second passport will expire on June 29, 2016. Mr. Epstein anticipates an extremely rigorous international travel schedule. In the immediate future, he is schedule to travel to France on June 13, 2016, and we also anticipate him being required to travel on June 20, 2016 to for business matters. He will therefore need to obtain visas for these additional countries, and likely others, while traveling with his current passport in his possession, and respectfully requests that a second valid U.S. passport again be issued to him. We understand that the passport will only be valid for a limited period. If you have any questions, please feel free to call me at Should either Mr. Epstein's original 10-year passport, or, if issued, his limited validity (second valid) passport be lost or stolen, he will report the circumstances immediately to the Passport Office in Washington, DC, or, if abroad, to the nearest U.S. Embassy or Consulate. Thank you for your assistance with this matter. Sincerely, Darren K. Indyke General Counsel to Southern Trust Company, Inc. EFTA00316229