EFTA00098593.pdf

FDLE Florida Department of Criminal Investigations and Forensic Science Services Ron DeSardis, Governor Law Enforcement Enforcement and Investigative Support Ashley Moody. Attorney General Post Office Box 1489 Jimmy Patron's, ChiefFinancial Officer Richard L. Swearingen Tallahassee. FL 32303-1489 Nikki Fried. Commissioner ofAgricultun) Commissioner 1-888-357-7332 wwwfdle.staterius STATE OF FLORIDA COUNTY OF LEON CERTIFICATION OF DOCUMENTS REGARDING JEFFREY E. EPSTEIN , at the partment of Law Enforcement FOLE), Tallahassee, Florida. As a records custodian. I am responsible for maintaining records for Enforcement & Investigative Support, including, among other duties, receiving and recording information provided by persons Of agencies to this Department, either directly or indirectly, pursuant to the statutory duties imposed on such persons or agencies under Florida law to which there was a duty to report. I am familiar with the filing system for this information. After being duly sworn, I hereby certify that the attached document(s), consisting of 6 page(s) are true and accurate copies of records received and kept in the regular course of official business by this Department of electronic or hard copy FDLE Sexual Predator/Offender Registration forms electronically or manually submitted by persons or agencies with knowledge of the events and were made at or near the time of the events to FDLE on or about January 5, 2017 and maintained within the Florida Department of Law Enforcement's sexual offender database and/or physical hard copy file regarding JEFFREY E. EPSTEIN, a white male with the date of birth of January 20, 1953. Records Custodian) SWORN TO AND SUBSCRIBED before me this 14th day of January, 2019. i%y.. NCN.I L WARD 11:46tary Public or other person authorized t*1 Cortarisairt 0 GC 23860t to administer an oath (print, type or stamp ;1.5 Era a fir ank4 Thu leer Faia linnets 81416-7019 commissioned name of notary public) Personally known _produced identification Type of identification produced Service • Integrity • Respect • Quality EFTA00098593  Registration No: 916154 Person Number: 73274 FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM Agency Name: Palm Beach County SO "— Note: Your next ReRegistration month is July of 2017 Registration For: January 2017 - SEXUAL OFFENDER Reason For Registration O initial Registration El Scheduled Conegistration O lnlometIon Upden Eorty/Lene noRegoestion D Registrant Information Name JEFFREY E EPSTEIN 'SSW DOES Race: WNW Sex: Male (Frst Wade Last, Suns) Tisciesure of your Soda( Secunty Num ter (SSW) a mandatory pursuant to Floods law. SIC606$ 77521,943.0435, 944.807, Mat F.S.. and Weal Isw.42 USC 18901. et seq. Use of your SSN is be the purposes of ele att.:awn. FDLE me/ share the ttnxmaten wet the other seences for ilea purpose'. FL DLO( ID Card 0: Height 6'00' Weight: 180 lbS Halt Grey Eyes: roue Place of Binh. Immigration Status: Not Appicatis Currently on Probation/Parole: O No O yes Probation Type: O State Officer Name: Phone ( State O Federal Cry Officer Name: Phone: ( ) County Officer Name' Pl,nne ( ) Canty 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 stale/country Oars of Departure: O Temporarily leaving Florida to visit another state/country O Moving from another state to permanently establish a residence In Heckle Date of Arnval O Veiling from another state and establIsrang a temporary address in Florida O Other (please describe) Current Permanent Address Future Permanent Address 6100 Red Hook Quarters Ste B3 (Address Um 1) (Address Ure t) Little St Janes !stands (Address Line 2) (Address Line 2) St Thomas VI 00802 (Cry) (Stele) (Zip) (Cali (suite) (Za) Counts St Thomas End Dale: Counts Still Date O I do NOT have a permanent address at this thee. Page 1 of 6 2017-01-05 3'12 16 IN EFTA00098594  Registration No: 916154 Person Number: 73274 Temporary Addresses El l do NOT nava • temPore•Y address Please note: TM registrant has reported additional temporery eddressis• not displayed here 1. 358 El Bello Way Palm Beach FL 33480-4730 (Street Address) (City) (State) (Do) County Paint Beach Dates you will be at this address: From: 071262012 To: Transient Addresses Q I do NOT have a transient address 1. Parer address or button) (City) (State) (Ad Chu*: Dales you vial be at this address: From: To: Employment 1am currently unemployed. 1. Employer: Financial Trust Company 0004>a000: Owner Sian Dale: 07/26/2012 Address: 6100 Red Hook Quarter Ste B3 St Thomas VI 00)02 (Sheet Mans) (Coe Plate/ (Zip) County Saint Thomas Contact Person. Mailing Address Phone Numbers Pleas* note: The registrant has reported additional phone* not dispayed here. O ism* as Permanent name as Temporary ado NOT have or use any horns or mobile phone numbers 9 E 71st St Phone Number: Phone Type: (address Line 1) 1. Home (Address Line 2) 2. Roblin New York NY 10021 3. Fax (00/) (State) (Zip) 4. WO* County. New York End Gate: 5 Fax Campus Activity CI lard NOT a Stuart, employes, or volunteer et e university or Institution of highs' learning. 1. 0 Studera O Employee O Volunteer Stan Date End Date. University/School Name: Campus: Address: (Seem address) (Cray) (State) (Zip) County Err( loye- Contact: Professional Licenses El I do NOT has any professional licenses 1 (1.4„mbe" i.stuot by) Page 7 of 6 2017-01-05 3:12 irtp24 EFTA00098595  Registration No: 916154 Person Number: 73274 Passport O I do NOT Mtn • Passport 1. C134c1578 10/11/2016 10/10/2024 (Numboo Moue OEle) (Furaireerin lame) Email/Internet Identifiers O I do NOT use any ma addresses or Internet kientifieri. Pima note: The registrant has reported eddldonel anon* account, not displayed Mn. ctumboaclontollayahoo corn, J oeoroiectOyehoo con SCRXS/Ma theTaftoos ID I do NOT have tiny Score, Marks or Tenons. 1. (TYPO) (Locator') (Description) 2. hype) (Location) (3SsCdpeon) Vehicles Olds NOT awn or use a rebid,. RV, trailer or mobile home. Pins* note: The Indetriare Ma reported additional vehicle. not displayed here. 1. 2013 Ford EXPEDITION Black Truck (Veer) (Make) (Model) (ereorreolor Scheme) (Vehicle Type) 522rzz NM This vehicle Is El NOT used as a reerlence O Used se • ressience 0 Owned by registrant Nome Tag it) (Dab) 2. 2012 Coeliac OTHER Black IRKS (Vat) (Make) (tecess) (rokusColor Scheme) (Wilde Typo) b3455 NY This vehicle Is: Q NOT used as a residence O Used es a residents. 0 Owned by napidnani (Lama Tee in (Simla) Vessels CI I do NOT oven • vessel or houseboat. Please note: The registrant has reported addItIonal vessels not displayed here. 1. 2011 Other White ;Year) (Venal T>pot (Cobdcotri Sonoma) (Name ci Vessel ye; This vessel is El NOT used as • residence ❑ Used as • residence (Ftecisiration pl Adjudication Information Dale Adjudicated Crime Location of AdjudicatioNConviction Victm Information 1. (County) • (Slate)O lArbm OM" Gender. 2. (County) ISIS) O Moor O Gender: Were you or are you subject le registration a ozmmunity notification th another state? O Yes No If Yes. In what state? Page 3 ()le WIZ-oyes 3212.19114 EFTA00098596  Registration No: 916154 Person Number: 73274 NOTICE OF SEXUAL PREDATOR AND SEXUAL OFFENDER OBLIGATIONS Asa 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: Internet identifier means all electronic mail, chat, instant messenger, social networking. application software, or similar names used for Internet communication, but does not include a date of birth, social security number, or personal identification number (PIN). Voluntary disclosure by a sexual predator of his or her date of birth. social security number, or PIN as an Internet identifier waives the disclosure exemption in this paragraph for such personal information. "Permanent residence" means a place where I abide. lodge, or reside for 5 or more consecutive days. "Professional license" means the document of authorization or certification issued to me by an agency of this state for a regulatory purpose, or by any similar agency in another jurisdiction for a regulatory purpose, for me to engage In an occupation or cany out a trade or business. "Temporary residence" means a place where I abide. lodge, or reside, 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 my permanent address or, if my permanent residence is not in this state, a place where I am employed, practice a vocation, or am enrolled as a student for any period of time in this state. "Transient residence" means a county whore I remain, or am located for a period of 5 or more days in the aggregate during a calendar year and which is not my permanent or temporary address. The term includes, but is not limited to, a place where I sleep or seek shelter and a location that has no specific street address. "Vehicles owned" means any motor vehicle as defined ins. 320.01. which is registered, co-registered, leased, titled, or rented by me; a rented vehicle that I am authorized to drive; or a vehicle for which I am insured as a driver. The term also includes any motor vehicle as defined In s. 320.01, which Is registered, co-registered, leased, titled, or rented by a person or persons residing at my permanent residence for 5 or more consecutive days. 1. Within 48 hours of establishing or maintaining a residence in this state, or 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), I MUST report in anon to the local sheriffs office to register my temporary, transient, or permanent address and other information specified In statute. If I am convicted of an offense that requires registration and am not under custody and/or supervision of DOC I must report Inmom to the sheriffs office In the county of conviction within 48 hours of the conviction.(F.S. 943.O435(2Xe); 77521(8Xe)). FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY. 2. At registration, I MUST provide the following information to the department: name: date of birth: social security number; race; sex; height; weight; tattoos or other identifying marks; hair and eye color; photograph; all home telephone numbers end cellular telephone numbers; all electronic mail addresses and all Internet identifiers required to be provided pursuant to paragraphs. 943.0435(4)(e) F.S. or s. 775.21(8) (9)5 F.S.; address of all permanent and legs residences; address of any current temporary residence; any transient residence within the state; address, location, description and dates of any current or known future temporary residence within the state or out of state; occupation and place of employment; make, model, color, vehicle Identification number (VIN), and license tag number of all vehicles owned; date and place of each conviction; fingerprints; palm prints; and a brief description of the crime or crimes committed. I must also produce my passport (if I have one). If I am an alien, I must produce or provide information about documents establishing my immigration status. I must also provide information about all professional licenses I have. (F.S. 943.0435(2Kb); 775.21(8)(8)1.). FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY. 3. Within 48 hours after the initial registration of information as required in s2 above. I MUST report binge to the driver 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 license or identification card displaying one of the following designations: "SEXUAL PREDATOR" or "943.0435, F.S." unless a driver license or identification card with such designation was previously secured or updated. I must 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)(f)). FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A THIRD DEGREE FELONY. 4. Before using any electronic mail address or Internet Identifier I MUST report It using the online system maintained by the Florida Department of Law Enforcement or In Denson at the sheriffs office. OR, if I am on supervision with the Florida DOC or DJJ. this information MUST be reported to my probation officer before using such electronic mail addresses or Internet identifiers. (F.S. 943.0435(4X4)1.; 775.21(6Xg)5.a.1. FAILURE TO REPORT THIS INFORMATION PRIOR TO USE IS A THIRD DEGREE FELONY. Page 4 of 6 70174146312'19 PI! EFTA00098597  Registration No: 916154 Person Number: 73274 5. Each time my driver 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 license office to update my driver license or identification card and ensure that the driver license or identification card displays the designations as identified in e3 above. If I am unable to secure or update a driver license or identification card with DHSMV, I must also report any change of my residence or name within 48 hours after the change to the sheriffs office in the county where I reside or am located and provide confirmation that I reported the information to DHSMV. These reporting requireMerits do NOT negate the reettirement for me to obtain a Florida driver llcense,or ifeintifiCatien Calla required by this section.(F.S. 943.0435(4)(a), 775.21(6)(9)1.). FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A THIRD DEGREE FELONY. 6. If I am enrolled or employed, whether for compensation or as a volunteer at an institution of higher education in Florida, I MUST provide the name, address and county of each institution including each campus attended, and my enrollment, volunteer, or employment status. Each change In enrolment. volunteer, or employment status, I.e. commencement or termination, MUST be reported using the online system maintained by the Florida Department of Law Enforcement or in person at the sheriffs office within 48 hours after any change in status. OR, if I am on supervision with the Florida DOC or DJJ, this Information MUST be reported to my probation officer within 48 hours after any change in status. (F.S. 943.0435(2)(b)2.: 943.0435(14)(C)24 775.21(6Xa)1.b.; 775.21(8X1)24. FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY. 7. I MUST report all changes to home telephone numbers and cellular telephone numbers, Including added and deleted numbers within 48 hours of any change in the Information using the online system maintained by the Florida Department of Law Enforcement or in person at the sheriffs office. OR, if I am on supervision with the Florida DOC or DJJ, this information MUST be reported to my probation officer within 48 hours of any change. {F.S. 943.0435(4)(e)2.; 775.21(8X9)5.b.}. FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY. 8. I MUST report all changes to employment Information within 48 hours of any change In the Information using the online system maintained by the Florida Department of Law Enforcement or in person at the sheriffs office. OR, iI I am on supervision with the Florida DOC or DJJ, this information MUST be reported to my probation officer within 48 hours of any change. (F.S. 943.0435(4Xe)2.; 775.21(6) (915.b.}. FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY. 9. I MUST report any changes In vehicles owned within 48 hours Maroon at the sheriffs office. (F.S. 943.0435(2)(b)3.; 775.21(6)(8)1.cl FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY. 10. If I vacate a permanent, temporary. or transient residence, and do not have another permanent, temporary, or transient residence. I MUST report laPite.g0 to the sheriffs office in the county where I am located within 48 hours. (F.S. 943.0435(4)(b)1.; 776.21(602.a.). FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY. 11. It I report that I have vacated a permanent. temporary, or transient residence and then remain at that residence, I MUST report In oersog to the Sheriffs 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)(9)3.). FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY. 12. I understand that my address may be verified by county, state, or local taw enforcement agencies. IRS. 943.0435(8); 775.21(8)). 13. If I Intend on establishing a permanent, temporary, or transient residence in another state, jurisdiction, or country other than the State of Florida, I MUST report In person to the sheriffs office in the county of my current residence within 48 hours before the date that I intend to leave this state to establish residence In another state, or jurisdiction, or at least 21 days before my planned departure date if the intended residence of 5 days or more is outside of the United States. I MUST provide the address, municipality, county, state, and country of Intended residence. For international travel I MUST also provide my travel information, including, but not limited to, expected departure and return dates. flight number. airport of departure, cruise port of departure, or any other means of Intended travel. If I do not know of my travel outside of the United States 21 days before my departure date, then I MUST report In OtrIKKI to the sheriffs office in the county of my current residence as soon as possible before my departure.(F.S. 943.0435(7); 775.21(6X0)- FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 14. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida, or another country, and later decide to remain in this state, I MUST rapert trimmer' to the sheriffs office to which I reported my Intention of leaving the state within 48 hours after the intended departure date. (F.S. 943.0435(8); 775.21(6)(0). FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY. 15. I MUST report trigeneg either two tire's MUNN (during the month of my birth and during the 6th month following my birth month) or toll[ times (once during the month of my birth and every 3rd month thereafter), depending upon my offense/dealgnation, to the sheriffs office in the county in which I reside or am otherwise located to reregister, unless otherwise notified by FOLE.{F.S. 943.0435(14XaMb); 775.21(8X')). FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. Pope 5 of. 2917-01-0s 3.17 19 PM EFTA00098598  Registration No: 916154 Person Number: 73274 All sexual predators, sexual offenders convicted for offenses specified in F.S. 943.0435(14)(6). and juvenile sexual offenders required to register per F.S. 943.0435(1)(h)1.d. are required to reregister lour times per year. All other sexual offenders are required to reregister two times per year. Eli AM REQUIRED TO REREGISTER I AM REQUIRED TO REREGISTER TWO TIMES PER YEAR; I MUST FOUR TIMES PER 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 13O), Florida Statutes) Month I must Month I must Month I must reregister In: Month I must reregister In: of Birth reregister In: of Birth reregister in: of Birth of Birth 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 mars 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 6 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 16. In addition to the registration months listed above, I MUST report iniLiereen to the sheriffs office n the county in which I am located within 48 hours of establishing a transient residence and thereafter must report in Person every 30 days to the sheriffs office in the county in which I am located while I maintain a transient residence. I MUST provide the addresses and locations where I maintain a transient residence. (F.S. 943.0435(4Kb)2.; 775.2103X9)2.b.). FAILURE TO REPORT IS A THIRD DEGREE FELONY. 17. If I live in another state, but work or attend school in Florida. I MUST register my work or school address as a temporary address within 48 hours by reporting ID person to the local sheriffs office. (F.S. 943.0435(2)(a); 943.0435(2Kb)2.: 943.0435(14KC)2.; 775.21(6)(01.b.: 775.21(60)1.; 775.21(8X02.). FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 18. I MUST respond to any address verification correspondence from FOIE within three weeks of the date of the correspondence. {F.S. 943.0435(14Kc)4.; 775.21(10)M. FAILURE TO RESPOND AS REQUIRED IS A THIRD DEGREE FELONY. 19. If I am employed in, carry on a vocation in, am a student in, or become a resident of another state or jurisdiction, I am on notice that I may have a requirement to register under the laws of that state. 20. If I fail to register after crossing state lines I may be in violation of federal law as well as state statutes. 21. 1 MUST maintain registration for the duration of my life. (F.S. 943.0435(11); 775.21(6)(I)Y 22. KNOWINGLY PROVIDING FALSE REGISTRATION INFORMATION BY ACT OR OMISSION IS A THIRD DEGREE FELONY.{F.S. 943.0435(14)(c)4.; 775.21(10Xa)}. REGISTRATION INFORMATION IS PUBUSHED ON THE FDLE PUBUC SEXUAL PREDATOR AND OFFENDER WEBSITE. PLEASE READ CAREFULLY BEFORE SIGNING As a sexual predator (Florida Statute 775.21) or sexual offender (Florida Statute 943.0435, 944.607, or 985.4815), I am required by law to abide by the requirements fisted 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 TO REREGISTER EACH YEAR AT THE SHERIFF'S OFFICE IN THE MONTHS OF January AND July. Ftmnit Registrant: Witnessed by Reporting Officer: S gneiure Required Signature Roptated Printed Name: JEFFREY E EPSTEIN Date: 01105/2017 Printed Name Date: 01/05/2017 • OFFICIAL DOCUMENT DO NOT DESTROY* NOTE: Your next ReRegistration month Is July of 2017. Ptgo 6 of 6 7-01-05 3]219 20_77-01-05 EFTA00098599 FDLE Florida Department of Criminal Investigations and Forensic Science Services Ron DeSantis. Governor Law Enforcement Enforcement and Investigative Support Ashley Moody, Attorney General Post Office Box 1489 Jimmy Patronis, chief Financial Officer Richard L. Swearingen Tallahassee. FL 32303-1489 Nikki Fried. Commissioner of Agriculture Commissioner 1-888-357-7332 www.fdle.state.fl.us STATE OF FLORIDA COUNTY OF LEON CERTIFICATION OF DOCUMENTS REGARDING JEFFREY E. EPSTEIN , at the orida Department of Law Enforcement (POLE), Tallahassee. Florida. As a records custodian. I am responsible for maintaining records for Enforcement & Investigative Support, including, among other duties, receiving and recording information provided by persons or agencies to this Department, either directly or indirectly, pursuant to the statutory duties imposed on such persons or agencies under Florida law to which there was a duty to report. I am familiar with the filing system for this information. After being duly sworn, I hereby certify that the attached document(s), consisting of 6 page(s) are true and accurate copies of records received and kept in the regular course of official business by this Department of electronic or hard copy FDLE Sexual Predator/Offender Registration forms electronically or manually submitted by persons or agencies with knowledge of the events and were made at or near the time of the events to FDLE on or about July 11, 2016 and maintained within the Florida Department of Law Enforcement's sexual offender database and/or physical hard copy file regarding JEFFREY E. EPSTEIN, a white male with the date of birth of Janua 20 1953. eco •s ustodian) SWORN TO AND SUBSCRIBED before me this 14th day of January, 2019. -;) 2 0 1.4,t\ MOO L. WARD Notary Public or other person authorized ci Commission a GG 238601 to administer an oath (print, type or stamp gi Expires October 12, 2022 -":.- ce, 4' Bordid TM TanFinInmate 10)45-7011 commissioned name of notary public) Personally known or produced identification Type of identification produced Service • Integrity • Respect • Quality EFTA00098600  Registration No: 862790 Person Number: 73274 FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM Agency Name: Palm Beach County SO Note: Your next ReRegistration month is January of 2017 Registration For: July 2016 -SEXUAL OFFENDER Reason For Registration O miss areastrelion a Scheduled ReFtegistraton O ifilormenon Update O tenets. aeRegisrmion Registrant Information Name: JEFFREY E EPSTEIN 'SSN: DOS: (Few mos Lest Suffix) Race White Sex: Male 'Disclosure of your Social Securely Number (SSN) is mandatory pursuant to Folds Irw. Sictons 775.21. 943.043.5. 944.607. 986.451. F.S end federal law. 42 USC 15S0I. m seq. Use of your SSN is for the imposes of Metrication. F0LE may share the information with the of es agencies for the same purpose. Ft. DL or ID Card A E123425530200 Height 5. 00' Weight Ise les Hair Grey Eyes Blue Place of NT: Immigration Status: Not Applicable Currently on ProbatioNParole: El No El Yes Probation Type: O State Officer Name: Phone: ( ) Sesto 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) Permanently leaving Florida to establish a residence in another state/country mate of Departure: 0 Temporarily leaving Florkle to visit another stale/county 0 Moving from another slate to permanentfy estabash a residence in Florida Date of Arms': 0 Visaing from another state and establishing a temporary address in Florida 0 Other (please describe): Current Permanent Address Future Permanent Address 6100 Red Hook Quarters Ste 83 (Address Line 1) (address Line 1) Lithe St James islands (Address Line 2) (Address Una 2) St Thomas VI 00802 (Cory) (State) Rim May) i (State) (TV) County SI Thomas End Dale: County Start Date 0 I do NOT have a permanent address at Ills time. Page 1 dot 20160l-1I 10322 PM EFTA00098601  Registration No: 862790 Person Number: 73274 Temporary Addresses ado NOT have • temporary address Pima note: The recite trent hes reported additional temporary 'Adrenal, not displayed here. 1. 360 El Salo Way Palm Brach FL 33480-4730 (stem /Wren) (City) (Stele) (Zip) County. Pakn Beach Dates you will be at this address From: 07/26/2012 To: Transient Addresses a I do NOT Nays a banSat addren 1. (Street Address or location) (City) (Stem) Zip) County Dates you will be al this address: From: To Employment O i 11111 currently unemployed. 1. Employer: Financial Trust Company 0041-cabon: Owner Start Date: 07/26/2012 Address: 6100 Red Hook Quarter Ste 83 St Therms VI 00802 (Weil Address) (eiry) (State) (Zip) Cow* Saint Thomas Contact Person. Mailing Address Phone Numbers ROOS* note: registrant has reported additional The phones not displayed here. O see se peewee ❑tlentese Teeperaly O ldie NOT hen or use any horn* or mobile phone numbers 9E 71st St Phone Number: Phone Type: (Address Lino I) 1. m1)655-7626 Home (Address Line 2) 2. (212)533.3739 Mobile Now York NY 1(021 3. (561)656.3572 Fax (Cry) (SOW a) S. (304) 775-8135 Work County New York End Eisie: 5. (505)938-2924 Fax Campus Activity I ern NOT a student, employee, or volunteer at • university or Institution of higher learning. 1. E O Employee O Votiri!ntr Start Date. End Date. Unlyervty/Sthool Name. Campus: Addro5$ (Steel Address) (Sum) Rio County Employer Contact: Professional Licenses OI do NOT nave any professlortel licensee. 1. Inumber) n) 'yl Page 2 of 6 2j21+(17-11 1 03 32 per EFTA00098602  Registration No: 862790 Person Number: 73274 Passport El I do NOT hew • Preport InformalIon. (issue Date) Mahan Date) Email/Internet Identifiers . I do NOT use any serail addressee or ~mat lantifiea. Please not*: The registrant has reported additional on:Ine accounts not Ole plepad han. Email Addresses Internist Identifiers Narre. Provider 1. columbiadantell @yehoocom 1. 2. Merdonct@yahoo corn 2. __ Scars/Markarrattoos El I do NOT aye any Scare Mara or Tattoo.. . (Two) (LOoslIOn) ;Vase, ?Soo/ 2. Moe) (Location) Peltenlitin) Vehicles El I do NOT own or use • wade, RV. Wailer or MOW. home. Plato not*: The fogatinent has reported additional vehicles not displayed hors. 1. 2013 Ford EXPEDITION Bad< Trick (Year) (Make) (Mode) (Color/Coax Scheme) (Volta Type) 522rzz NM ITNO. VONCIO NOT use.] as a endows El Used asa ~woe 0 owned by relPalten (Liens TagI) (Stole) 2. 2012 Cadillac OTHFR Black Truck (Tar) (Mae) (Model) (Cedar/Gar Shame) (Valid* Tr») 114455 NY This vehicle is 9 NOT used as a mallets D used as a residence D Owned by regnant (Lama Tag 8) ($1848) Vessels D I do NOT own • veal or houaboa. Phan note: The raietraM has reported ~Morel vessels not displayed here. 1. 2011 Other White (TS) (Vaal Tao) (Celor/Colo• Schwa) (Name of Vesale) yea 11* yens as: El NOT laic as • =dace D Used es • residence (Registration le Adjudication Information Dale Acfpuchcaled Come Location of Adjudir.alioniConectiOn Victim Inky-Mahon 1. ua OAOo Gender. (County) (State) 2. (Carry) (Suite) ❑ Minor D Ad, Gender Were you or are you subject to registration or community notification In another stole? area No If Yes, in what slate? _ Page 3 016 201647.11 1:4332 PL EFTA00098603  Registration No: 862790 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 I abide, lodge, or reside for 5 or more consecutive days. "Temporary residence" means a place where I abide, lodge, or reside, 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 my perman