EFTA01107947.pdf

Registration No: 353899 Person Number: 73274 FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM Agency Name: Palm Beach County SO nee Note: Your next ReRegistration month is July of 2011 ***** Registration For: January 2011 - SEXUAL OFFENDER Reason For Registration O Initial Registration 0 Scheduled ReRegistration O Intimation Update ❑ Early.Late ReRegistration Registrant Information Name: JEFFREY E EPSTEIN •SSN: Race: White (First Middle Last. Suffix) Sex: Male 'Disclosure of your Social Security Number (SSN) is mandatory pursuant to Fonda law. sections 775.21. 943.0435. 944.607. 955.481. F.S.. and federal law. 42 USC 16901. et seg. Use of your SSN 5 for the purposes of Identification, FDLE may share the information wyth the other agencies for the same purpose. FL DL or ID Card #: £123425530200 Height: 6' CO " Weight 180 lbs Hair: Grey Eyes: Blue Place of Birth: United States Of America (usa) Currently on Probation/Parole: ❑x No O Yes Probation Type: ❑ State Officer Name: Phone: ( ) State ❑ Federal Officer Name: Phone: ( ) City 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 stale O Moving from another state to permanently establish a residence in Florida Date of Arrival: 1/17/2011 O Visiting from another state and establishing a temporary address in Florida O Other (please describe): will be at temp address from 01/17/2011 . 01/20/2011 Previous Permanent Address Current Permanent Address 6100 Red Hook Quarters Ste 83 (Address Line 1) (Address Una 1) Little St James Islands (Address Line 2) (Address Line 2) St Thomas VI 00802 (City) (State) (Zip) (O,Y) (State) (Zip) County: End Date: Count,: St Thomas Stan Date: 07/19/2010 O I do NOT have a permanent address at this time. Page 1 of 6 2209AM EFTA01107947  Registration No: 353899 Person Number: 73274 Temporary Addresses 0 I do NOT have a temporary address Please note: The registrant has reported additional temporary addresses not displayed here. 1. 49 Zara Renal Rd Stanley NM 87056-9743 (Street Address) — (City) ' (Sate) (23p) County Santa Fe Dates you will be at this address. From: To: 2. 22 Avenue Foch 2dd Paris YY 00000 (Street Address) (Oily) (Sloe) ' (Z17) County: page Dates you will be at this address: From: To: 3. 9 E 71st St New York NY 10021.4102 (Street Address) (CItY) ' MAIO MP/ County: New York Dales you will be at this address: From: To: _ Transient Addresses 9 I do NOT have a transient address 1. (Street Address or locaticn) (City) ' (State) (Zip) --- ' County: Dates you will be at this address: From: To: 2. (Street Address a location) (City) (State) (Zip) County: Dates you will be al this address: From: To: 3. (Street Address or salon) (City) ' (State) (zap) County Dates you will be at this address: From: To: Employment 0 I am currently unemployed. 1. Employer F T C Occupation: Ovine, Start Date: Address: 8100 Redhook Quarter Ste B3 St Thomas YY 00802 (Street Address) (City) (Slate) (re) County. Us Virgin Islands Contact Person: 2. Employer: Occupation: Start Date: Address: (Street Address) (City) ' (State) (Zip) County: Contact Person: 3. Employer. Occupation: Start Date: Address: (Street Address) (City) ' fr e) (ZO) County: Contact Person: Page 2 of 6 :011.01-18 10122:09AM EFTA01107948  Registration No: 353899 Person Number: 73274 Mailing Address Phone Numbers Please note: The reglalraM has reported additional phones not displayed here. 0 Same as Permanent 0 Same as Temporary 0I do NOT have or use any home or mobile phone numbers 9 E 71st St Phone Number. Phone Type: (Address Line 1) 1. (561)655-7621 Home (Address Line 2) 2. (561)655-7626 Home -- New York NY 10021 3. (212)533-3739 (CRY) Mobile (State) Poi 4. (561)601.4569 Mobile Oautity. NewYodc End Date, 5 (561)832.2104 Fax Vehicles ED I do NOT own or use a vehicle. RV. trailer or mobile home. Please note: The registrant has reported additional vehicles not displayed here. 1. 2005 Cadillac Other Black (Year) (Make) Truck (Model) (Cob/Color Scheme) Nehicle Type) This vehicle Is: 0 NOT used as a resklence 0 Used as a residence (License Tag ft) (Stele) 2. 2002 Mercedes-bent 500 Series Black (Year) (Make) Auto (Model) (Color/Color Scheme) (Vehicle Type) C165SP FL This vehicle is: 0 NOT used as a residence 0 Used as a residence (License Tag I) (State) 3. 2010 Chevrolet Surburban (Year) Black Truck (Make) (Model) (ColonColor Scheme) (Vehicle Type) This vehicle Is 0 NOT used as a residence El Used as a residence (License Tag 0) (Stale) 4. 2006 Bentley Amage (Year) Black Auto (Make) (Model) (Color/Color Scheme) (Vehicle Type) V752DS FL This vows is: 9 NOT used as a rosidence 0 Used as a residence (License Tag et (State) Vessels a I do NOT own a vessel or houseboat. Please note: The registrant has reported additional vessels not displayed here. 1. 2010 (M=r White .... (Year) iVesse. Typo) -- (CoIotiCok) Scheme) (Name of Vessel) This vessel is: 0 NOT used as a residence 0 Used as a residence (Registration ($) 2. 2000 Other White (Year) (Neese( TYPO (ColodColor Scheme) (Name of Vessel) (Registration A) This vessel is: El NOT used as a residence D Used as a residence 3. 2006 Jefski Black (Year) MSS Type) (Color/Color Scheme) (Name of vessel) 1245L506 This vessel is: [fl NOT used as a residence 0 Used as a residence (Registration I) 4. 2008 Other White Little C (Year) (Vessel Type) (CciodColcf Scheme) (Name of Vessel) WAF1016B808 This vessel is: 0 NOT used as a residence ❑ Used as a residence (Registration *) Page 3 old 2011-01.18 102200Am EFTA01107949  Registration No: 353899 Person Number: 73274 Campus Activity DI am NOT a student. employed. or volunteer at a university or institution of higher learning. 1. O Student O Empoyee O VOlunloor Start Date: End Date: University/School Name: Campus: Address: (Street Address) (City) (State) (Zip) County: Employer. Contact: 2. . Student O Employee O Volunteer Start Date: End Date: University/School Name: Campus: Address: (Street Address) OW ' (State) (Zip) County: Empleyec Contact: 3. ❑ Student O Employee O Volunteer Start Date: End Date: University/School Name: Campus: Address: (Street Address) PM (State) (ZIP) County: Employer. Contact Cyber Communication Accounts t do NOT use any email addresses or Instant Message screen names. Email Addresses Instant Message Screen Names Name: Provider. 1. 1. _ 2. 2. _ 3. 3. _ 4. jeevacationg 4. __ 5. 5. Adjudication Information Date Adjudicated Crime Location of Adjudication/Conviction Victim Information 1: , O min?' O Mull Gender: (County) (State) 2. (County) (Stale) O Minor O mull Gender: 3. (County) I (State) O Minor O Adult Gender: 4. O Minor O Adult Gender: (County) (Slate) Were you or are you subject to registration or community notification in another state? O Yos 0 No If Yes, in what state? Page 4 ore 2O_Usit-i a w22...09 AM EFTA01107950  Registration No: 353899 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 985.481) 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 in pecson 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 Department of Corrections (DOC), Department of Children and Family Services (DCFS), or 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)1). 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(4Xd) 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)1}. 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. {F.S. 943.0435(3); 775.21(6)(f)). 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 idenification card and ensure that the drivers license or identification card displays the designations as identified in requirement #3. {F.S. 943.0435(4)(a); 775.21(6)91). 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 Sheriff's Office; OR, for a sexual offender on supervision with the Florida (DOC) or (DJJ), this information must be reported to the sexual offender's probation officer, within 48 hours after any change in status. {F.S. 943.0435(2)(b)2; 775.21(6)(a)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)(g)4}. 7. If I vacate a permanent, temporary, or transient residence, and do not have another permanent, temporary, or transient residence, I MUST report in person 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 MUSTreport 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(4)(c); 775.21(6)(9)3). Page 5 of 6 2911-01-18 1022-09Ahl EFTA01107951  Registration No: 353899 Person Number: 73274 9. I understand that my address will be verified by county, state or local law enforcemen t agencies. {F.S. 943.0435(6);775.21(8)). 10. If I intend on establishing a permanent, temporary, or transient residence in another state or jurisdiction other than the State ofFlorida, I MUST report in person to the Sheriffs Office of 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. {F.S. 943.0435(7); 775.21(6)(i)). 11. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida and later decide to remain in this state, I MUST report In person to the Sheriffs Office to which I reported my intention of leaving the state within 48 hours after the intended departure date. Failure to report this information is a felony in the second degree. {F.S. 943.0435(8); 775.21(6)(j)}. 12. I MUST report in person either twice a year (during the month of my birth and during the 6th month following my birth month) or four times a year (once during the month of my birth and every 3rd month thereafter), depending upon my offense/ designation, to the Sheriffs Office in the county in which I reside or am otherwise located to reregister. {F.S. 943.0435(14) (a); 775.21(8)(a)}. NOTE: All Sexual Predators, Sexual Offenders convicted for offenses specified In F.S 943.0435(14 ), and Juvenile Sexual Offenders required to register per F.S 943.043591)(a)1.d are required to reregister four times a year. All other Sexual Offenders are required to reregister twice a year. I AM REQUIRED TO REREGISTER I AM REQUIRED TO REREGISTER FOUR TIMES A TWO TIMES A YEAR; I MUST YEAR; I MUST REREGISTER AS NOTED BELOW. REREGISTER AS NOTED BELOW. {Sexual Predators (775.21) and Sexual Offenders {Sexual Offenders (943.0435), (985.481), unless otherwise notified by FDLE} unless otherwise notified by FDLE} 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 8 Mar 13. 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 in person to the local Sheriffs Office.(F.S. 943.0435(2); 775.21(6)(a)1b). 14. I MUST respond to any address verification correspondence from POLE within three weeks of the date of the correspondence. {F.S. 943.0435(14)(c)4; 775.21(10)(a)}. 15. If I am employed, carry on a vocation, am a student, or become a resident of another state, I am on notice that I may have a requirement to register under the laws of that state. 16. I MUST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(1)y PLEASE READ CAREFULLY BEFORE SIGNING As a Sexual Predator (Florida Statute 775.21) or Sexual Offender (Florida Statute 943.0435, 944.607. or 985.481), 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 TO REREGISTER EACH YEAR AT THE SHERIFF'S OFFICE IN THE MONTHS OF January AND July. rnserzia Registrant: Witnessed by Reporting Officer: Signature Required Signature Required Printed Name: JEFFREY E EPSTEIN Date: 01/18/2011 Printed Name: OBED LEIVA Date: 01118.12011 • OFFICIAL DOCUMENT DO NOT DESTROY' •••••• NOTE: Your next ReRegistration month is July of 2011. ant Pago 6 of 6 2011-01A8 1O27.99.1al EFTA01107952