EFTA01111782.pdf

Registration No: 353899 Person Number: 73274 FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM Agency Name: Palm Beach County SO ***** Note: Your next ReRegistration month is July of 2011 ***** Registration For: January 2011 - SEXUAL OFFENDER Reason For Registration Initial Registration El 0 Scheduled ReRegistraban O Intonnattan Update O Early/ ate ReRegistration Registrant Information Name: JEFFREY E EPSTEIN *SSN: =MI DOB: 01120/1953 Race: (First Middle Last. Suffix) White Sex: Male 'Disclosure of your Social Secure), Number (SSN) is mandatory pursuant to Florida law. sertlons 77621.943.0435 , 944.807, 085.481, FS.. end federal law. 42 USC 16901. et seq. Use of your SSN is for the purposes of identificatian.FDLE may share the information with the other agencies let the same purpose. FL DL or ID Card #: E123425530200 Height. 6' 00' Weight: 180 lbs Hair Grey Eyes: Blue Place of Birth: United States Of America (usa) Comely on Probation/Parole:ado Yes O Probation Type: O State Officer Name: Phone: ( ) Sins 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 stale Date of Departure: 0 Temporarily leaving Florida to visit another state 0 Moving from another state to permanently establish a residence in Florida Date of Arrival Imereem. c thothi e.X Visiting from another state and establishing a temporary address in Florida Other (please describe): will be at temp address tram 1 .) 41 )cHa- — C." ho t)/ Previous Permanent Address Current Permanent Address 6100 Red Hook Ouarter4Sle 83 (Address Lino I) (Address Line 1) Little St James Island* 4._ (Address Line 2) (Address Line 2) St Thomas VI 00802 (Coy) (SIMs) (a) (City) (Stale) (Zip) County: End Date: County: St Thomas Stan Date: 07/19/2010 01 do NOT have a permanent address at this time. Page 1 of 6 201141.16102209 AM EFTA01111782  Registration No: 353899 Person Number: 73274 Temporary Addresses • I do NOT have a temporary address Please noto: The registrant has reported additional temporary address es not displayed here. 1. 49 Zorro Ranch Rd Stanley (Street Address) — NM 87056-9743 (City) (State) (Zg) County: Santa Fe Dates you will be at this address: From: To: 2. 22 Avenue Foch 2dd Pads TY (Street Address) 00000 (Coy) (State) (Zip) I County-. Paris Dates you will be al this address: From: To: 3. 9 E 71st St New York NY (Street Address) 10021.4102 (City) (State) (Zip) County: New York Dates you will be at this address: From: To: . - r3vt - 358 a eat g- Pst• -• 334>f Co • Stil Transient Addresses 0 I do NOT have a transient address 1. (Street Address or location) (City) (State) (Zip) County: Dates you will be at this address: From: To: 2. (Street Address or location) (City) (State) (Zip) County: Dates you will be at this address: From: To: 3. (Street Address or location) (City) (State) (Zip) County: Dates you will be at this address: From: To: Employment ii l am currently unemployed. 1. Employer: 8.8se- v ivzocinA ,--p.v.4_ (avian: 40c. Occupation. Owner sten Date: Address: 6100 Redhook Quarter Ste 93 SI Thomas YY (Street Address) 00802 (City) (Stale) (Zip) County: LISYirgin Islands Contact Person: 2. Employer: Occupation: Start Date: Address: (Street Address) (Grey) ' (Stew) (Zip) County: Contact Person: 3. Employer. r Occupation: Start Date: Address: (StreetAddress) (City) (State) (Zip) County: Contact Person: Page 2 ol 6 2011-01.1810:27.09 Akf EFTA01111783  Registration No: 353899 Person Number: 73274 Mailing Address Phone Numbers Please note: The registrant has reported addiiiontl phones not displayed here. 0 -157no as Permanent 0 Same as Temporary D I do NOT have or use any home or mobile phone numbers SISIMIS (c2 ton ietO kirk a.iiar -1-e V' Phone Number. Phone Type: (Address tine a. 1 Sles- t .& t" — 3 (Address Une 2) 2 Home V I caw -:)_. timakik- SA-1w MALLS Ste. aeilli.• 3 Motile (IT) iSle) (7-0) 4 i eriAit:rVA ttptA iell imilolliller Canty: (S End Cele: 5 Fax Vehicles El I do NOT own or use a vehicle. RV. trailer or mobile home. Please note: The registrant has reported additional vehicles not displayed here. & rola:e.:I raidet_ 1. 2005 Cadillac &wk. Truck (Year) (Make) (hlodei) (Color/Cora-Scheme) (White Typo) 0:141ct4tre. .FL This vehicle is: 0 NOT used as a residence 0 Used as a residence (License Tap II) (Mete) 2. 2002 Mercedes-benz 500 Series Black Auto (Yew) (Make) (Model) (Cokir/Color Scheme) (Vehicle Type) C165-413 FL This vehicle is: El NOT used as a residence 0 Used as a residence (Lioanse Tap a) (Sate) 3. 2010 Chevrolet Surburben Black Truck (Veer) (Make) (Model) (Cora/Color Scheme) (Vehicle Type) This vehicle Is: 9 NOT used as a residence 0 Used as a residence Passe Tags) (Slag) 4. 2006 Bentley Amage Black Auto (UM) (Make) (Model) (Cdor/Oolor Scheme) (Vehicle Type) V75205 FL This vehicle Is: 9 NOT used as a residence 0 Used as a residence (License Tag a) (State) Vessels 0 I do NOT own a vessel or houseboat. Please note: The registrant has reported additional vessels not displayed here. 1. 2010 Other White (Year) (Vesse: Type) (Color/Coto Scheme) (Name of Vessel) This vessel is: a NOT used as a residence 0 Used as a residence (Registration in 2. 2000 Other White (Year) (Vessel Type) (ColodColor Scheme) (Name of Vessel) This vessel IS: El NOT used as a residence ['Used as a residence (Registration a) 3. 2006 Jet-ski Black (Year) (Vesse Type) (Color/Color Scheme) (Name of Vessel) 12451506 This vessel is: 9 NOT used as a residence 0 Used as a residence (Registration ff) 4. 2008 Other White Little C (Year) (Vessel Type) (Color/Color Scheme) (Name of Vessel) WJ1F10168808 This vessel is: 9 NOT used as a residence 0 Used as a residence (Registration N) Page 3 of 6 2011-01-113 1022:00Am EFTA01111784  Registration No: 353899 Person Number: 73274 Campus Activity 0 I am NOT a student. employee. or volunteer at a university or Institution of higher learning. 1. O S": Student El Empoyoo O Vo.otec, Start Dale' End Date: University/School Name: Campus: Address: (Street Address) (CaY) ' (Stale) (Zip) County: Employer: Contact 2. El Student O Employee O Weteiteei Start Date: End Date: University/School Name: Campus: Address: (Street Address) (City) (State) (Zip) County: Employer. Contact: 3. O Student O Employee O Wfunteet Start Date: End Date: University/School Name: Campus: Address: (Street Address) (City) i (State) (Zip) County: Employer Contact: Cyber Communication Accounts O i do NOT Lict, any email addresses or Instant Message screen namos. Email Addresses !Want Message Screen Names Name: Provider: 2. 2. OW .r- 3 3. ISM oak 4. i 4. 5. 5. Adjudication Information Dale Adjudicated Curie Location or Adjudication/Conviction Victim Information 1. (County) ' — (St— ate) — O Minor O Acto Gender. 2. (County) ' W) O klil°r O Adult Gender: 3. ____. O Minor O Adult Gender: (County) ' (Stale) 4. , O Minor O Adult Gender (County) (State) Were you or are you subject to registration or community notifica tion in another state? aYes 0 No If Yes. in what state? Page 4 of 6 20.3611a22.49.AM EFTA01111785  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 by law to abide by the following: I am required 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, business. or personal travel destinations in or out of this vacation, state, for a period of 5 or more days in the aggregate calendar year and which is not the person's permanent during any address or, for a person whose permanent residence state, a place where the person is employed, practices a is not in this 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 the aggregate during a calendar year and which is not more days in the person's permanent or temporary address. The term is not limited to, a place where the person sleeps or seeks includes, but shelter and a location that has no specific street addres s. FAILURE TO COMPLY WITH ANY OF THE FOLLOW ING REQUIREMENTS IS A FELONY OF THE THIRD DEGREE (UNLESS OTHERWISE NOTED). 1. I MUST report ingerson to the local Sheriffs Office within 48 hours of establishing or maintaining a residence within 48 hours of release from custody and/or superv in this state, ision of Department of Corrections (DOC), Department and Family Services (DCFS), or Department of Juven of Children ile Justice (DJJ), or in the county of conviction within conviction if not under custody and/or supervision of DOC 48 hours of to register my temporary, transient, or permanent addres other information specified in statute. {F.S. 943.0435(2)(a); s and 775.21(6)(e)1). 2. At initial registration, I MUST provide the following inform ation to the department: name, date of birth, social securi race, sex, height, weight, hair and eye color, photograph, ty number, home telephone number and any cellular telephone numbe electronic mail address and any instant message name r, any required to be provided pursuant to paragraph s.943.0435(4 F.S., address of legal residence, address of any curren )(d) t temporary residence, if no permanent or temporary reside transient residence within the state, dates of any curren nce, any t or known future temporary residence within the state or occupation and place of employment, date and place out of state, of each conviction, fingerprints, and a brief description or crimes committed. {F.S. 943.0435(2)(b): 775.21(6)(a)1}. of the crime 3. Within 48 hours after the initial report required as stated in requirement #2 above, I MUST report in person license office of the Department of Highway Safety and to the drivers Motor Vehicles (DHSMV) and provide proof of initial registr as a sexual offender or predator to secure or renew a valid ation Florida driver's license or identification card displaying of the following designations: -775.21, F.S." or "943.0435, one F.S.", unless a driver's license or identification card with designation was previously secured or updated. The sexua such l offender shall submit to the taking of a photograph for the department in maintaining current records of sexua use by l 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 temporary, or transient residence or change in name made my permanent, by marriage or other legal process, I MUST report in.pArf driver's license office to update my driver's license or identif fisie to a ication card and ensure that the driver's license or identifi card displays the designations as identified in requirement #3. cation {F.S. 943.0435(4)(a); 775.21(6)g1). 5. If I am enrolled, employed or carrying on a vocation at an institution of higher education in Florida, I MUST provid address and county of each institution including each campu e the name, s, enrollment or employment status. including each in enrollment or employment status, i.e. commencement change or termination, [parson at the Sheriff's Office; OR, for offender on supervision with the Florida (DOC) or (DJJ), this a sexual information must be reported to the sexual offender's probat officer, within 48 hours after any change in status. {F.S. ion 943.0435(2)(b)2; 775.21(6)(a)b}. 6. I MUST report any electronic mail address or instan t message name, prior to using such, during registr or by providing all updates through the online system ation/reregistration maintained by the Florida Department of Law Enforc {F.S.943.0435(4)(d); 775.21(6)(g)4}. ement. 7. If I vacate a permanent, temporary, or transient reside nce, and do not have another permanent, temporary, residence, I MUST report in_person to the Sheriffs Office or transient in the county where I am located within 48 hours. {F.S.9 (b); 775.21(6)(g)21. 43.0435(4) 8. If I report that I have vacated a permanent, temporary, or transie nt residence and then remain at that residence, I in_person to the Sheriffs Office where I reported vacating my MUSTreport residence. Failure to report this information is a felony second degree. {F.S. 943.0435(4)(c); 775.21(6)(g)3}. of the Page 5 a 6 2011-01.18 10:22S9_Abi EFTA01111786  Registration No: 353899 Person Number: 73274 9. I understand that my address will be verifie d by county, state or local law enforcement 943.0435(6);775.21(8)}. agencies. {F.S. 10. If I intend on establishing a permanent. temporary, or transient residence in another state or jurisdiction ofFlorida, I MUST report in person to the Sheriffs Office other than the State of the county of my current residence within 48 hours date that I intend to leave this state to establish reside before the nce 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 of Florida and later decide to remain in this state, I MUST report than the State 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 felony in the second degree. {F.S. 943.0435(8); 775.21(6)(j)}. is a 12. I MUST report in person either twice a year (during the month of my birth and during the 6th month month) or four times a year (once during the month of my following my birth birth and every 3rd month thereafter), depending upon my designation, to the Sheriffs Office in the county in which offense/ I reside or am otherwise located to reregister. {F.S. 943.04 (a): 775.21(8)(a)}. 35(14) NOTE: All Sexual Predators, Sexual Offenders convi cted for offenses specified in F.S 943.0435(14), and Sexual Offenders required to register per F.S 943.04 Juvenile 3591)(a)1.d are required to reregister four times a year. Sexual Offenders are required to reregister twice a All other year. 0 I AM REQUIRED TO REREGISTER El I AM REQUIRED TO REREGISTER FOUR TIMES TWO TIMES A YEAR; I MUST A 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 & Mar 13. If I live in another state, but work or attend school in Florida, I MUST register my work or school address address within 48 hours by reporting in person to the local as a temporary Sheriffs Office.{F.S. 943.0435(2); 775.21(6)(a)1b). 14. 1 MUST respond to any address verification corres pondence from FDLE within three weeks of the correspondence. (F.S. 943.0435(14)(c)4; 775.21(10)(a date of the )). 15. If I am employed, carry on a vocation, am a studen t, or become a resident of another state, I am on notice a requirement to register under the laws of that state. that I may have 16. I MUST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(1)). PLEASEBLEAP_C_AREBILLYJEIEEQBE SIGNING As a Sexual Predator (Florida Statute 775.21) or Sexual Offend er (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 January AND July. THE SHERIFF'S OFFICE IN THE MONTHS OF linsderit Registrant: Witnessed by Reporting Officer: Signature Required Printed Name: JEFFREY E EPSTEIN CA (34 J- Signature Required Date: OaMeglOct Printed Name: CIORPIPOOFfCt. gaitsyski 1... Date: • OFFICIAL DOCUMENT DO NOT DESTROY' ***** NOTE: Your next ReRegistratIon month Is July of 2011. Page 6 of 6 ZffIl-01-18 1O2.109AM EFTA01111787