EFTA00312852.pdf

U.S. Department of Justice Federal Bureau of Investigation Washington, D.C. 20535 Privacy Waiver and Certification of Identity Full Name: Jeffrey E. Epstein Aliases used: 6100 Red Hook Quarter, Suite B3, St. Thomas, USVI 00802 Current Address: Date of Birth: January 20, 1953 Place of Birth: Kings County, New York Social Security Number (optional): (Optional: Prior addresses, employments, etc.. which may assist the FBI in locating the requested information) I hereby waive my right to privacy, and I authorize the FBI to release any and all information relating to me to: (Name, address & phone of attorney or other designee) Under penalty of perjury, I hereby declare that I am the person described above and understand that any falsification of this statement is punishable under the provisions o Title 18, United States Code (U.S.C.), Section 1001 by a fine of not more than $10,000 or by imprisonment more than five years, or both; and that requesting or obtaining any record(s) under false pretenses i ishable under the provisions of Title 5, U.S.C., Section 552a (i)(3) as a misdemeanor by a fine of not than $5,000. Signature: Date: EFTA00312852