EFTA01699742.pdf

a EFTA01699742  U.S. Department of Justice United States Attorney Southern District ofNew York The Silvio J. Mono Building One Saint Andrew} Plcca New York New York 10007 June 15,2020 BY FAX lo= To whom it may concern: Please be advised that the accompanying grand jury subpoena has been issued in connection with an official criminal investigation of a suspected felony being conducted by a federal grand jury. The Government hereby requests that you voluntarily refrain from disclosing the existence of the subpoena to any third party. While you are under no obligation to comply with our request, we are requesting you not to make any disclosure in order to preserve the confidentiality of the investigation and because disclosure of the existence of this investigation might interfere with and impede the investigation. If you intend to disclose the existence of this Grand Jury Subpoena request to a third party, please let me know before making any such disclosure. Thank you for your cooperation in this matter. Sincerely, GEOFFREY S. BERMAN United States Attorney By: "A_ - - Assistant United States Attorney Telephone: EFTA01699743 INIIMms. EFTA01699744 Grand Jury Subpoena PnitetroStatesPiztrict Court SOUTHERN DISTRICT OF NEW YORK TO: AT&T Wireless Legal Compliance 11760 Highway 1, Suite 600 North Palm Beach, FL 33408 GREETINGS: WE COMMAND YOU that all and singular business and excuses being laid aside, you appear and attend before the GRAND JURY of the people of the United States for the Southern District of New York, at the United States Courthouse, 40 Foley Square, Room 220, in the Borough of Manhattan, City of New York, New York, in the Southern District ofNew York, at the following date, time and place: Appearance Date: July 6, 2020 Appearance Time: 10:00 a.m. to testify and give evidence in regard to an alleged violation of : 18 U.S.C. §§ 1591, 1594(c), 2423(a), 2422(b) and not to depart the Grand Jury without leave thereof, or of the United States Attorney, and that you bring with you and produce at the above time and place the following: See Attached Rider Personal appearance is not required if the uested records are (1) roduced by on or before the return date to Special Agent , telephone: or via email at ; and (2) accompanied by an executed copy of the attached Declaration of Custodian of Records. PLEASE PROVIDE IN ELECTRONIC FORMAT IF POSSIBLE. Failure to attend and produce any items hereby demanded will constitute contempt of court and will subject you to civil sanctions and criminal penalties, in addition to other penalties of the Law. DATED: New York, New York June 15, 2020 GEOFF E .GERMAN United States Attorneyfor the Southern District ofNew York Assistant United States Attorney One St. Andrew's Plaza New York, New York 10007 Telephone: EFTA01699745  RIDER (Grand Jury Subpoena to AT&T. dated June 15. 2020) Please provide any and all records (including, but not limited to, incoming and outgoing calls with any call details, local and long distance usage details, all subscriber opening and/or registration documents, all subscriber identification and contact information, all subscriber billing and payment information, SMS/text messaging records, IP history and login records, associated email addresses and/or screen names, and any additional accounts associated with any of the below-listed names, identifiers, addresses, phone numbers, and accounts listed and associated records for those accounts) relating to the following telephone numbers, as listed below, for the time period of March I, 2020 to the present: • N.B.: Personal appearance is not required if the requested records are (1) produced by on or before the return date to Special , telephone: or via email at and (2) accompanied by an executed copy of the attached Declaration of Custodian of Records. PLEASE PROVIDE IN ELECTRONIC FORMAT IF POSSIBLE. IMPORTANT: REQUEST FOR NON-DISCLOSURE Due to the ongoing nature of the investigation, it is requested that you do not disclose any information relating to this Crand Jury subpoena request to any third party. EFTA01699746  Declaration of Custodian of Records Pursuant to 28 U.S.C. § 1746, I, the undersigned, hereby declare: My name is (name of declarant) I am a United States citizen and I am over eighteen years of age. I am the custodian of records of the business named below, or I am otherwise qualified as a result of my position with the business named below to make this declaration. I am in receipt of a Grand Jury Subpoena. dated June 15, 2020. and signed by Assistant United States Attorney . requesting specified records of the business named below. Pursuant to Rules 902(1I) and 803(6) of the Federal Rules of Evidence, I hereby certify that the records provided herewith and in response to the Subpoena: (1) were made at or near the time of the occurrence of the matters set forth in the records, by, or from information transmitted by, a person with knowledge of those matters; (2) were kept in the course of regularly conducted business activity; and (3) were made by the regularly conducted business activity as a regular practice. I declare under penalty of perjury that the foregoing is true and correct. Executed on (date) (signature of declarant) (name and title of declarant) (name of business) (business address) Definitions of terms used above: As defined in Fed. R. Evid. 803(6), "record" includes a memorandum, report, record, or data compilation, in any form, of acts, events, conditions, opinions, or diagnoses. The term, "business" as used in Fed. R. Evid. 803(6) and the above declaration includes business, institution, association, profession, occupation, and calling of every kind, whether or not conducted for profit. EFTA01699747 r PERSONAL IDENTIFICATION F0443 (R SEE REVERSE SIDE FOR F LW HER NS'RuCTIONS 4413) LAS NAM L INFORM/G:0N IN BLACK FIRST NAME MIDDLE MME FIN LEAVE BLANK SIOPNWRE OF PERSON FINGEPPRNTIO ARROFTS SUBMITTED BY RE90ENCE OF PERSCN RPRIPITEO GATEOF SRTN DO 'Arit De, 'Ps F N N71 140 G BLN LF DUE FINGERPRICED X RAC HOT RGT EYES HAIR PLACE OF OATH Foe •tigrom BE NOTWIEC M CASE OF ELERGERCY RAW LEAVE BLANK %CC14 SECURITY ADORE SS IASCELLANEOUS SO Non -Federal Confidential Screening FINCER• 4 %' SCARS AP, R THuia SR 6L THUMB I 7 LEFT [VA APP:414STAPIN SPAILLANCOUSt+ I I TALUS I ft PAPPAS iti]Aff co. CP4C4RI 'WENlativti•MOUtix EFTA01699748  FEDERAL BUREAU OF INVESTIGATION UNITED STATES DEPARTMENT OF JUSTICE CRIMINAL JUSTICE INFORMATION SERVICES DIVISION, CLARKSBURG, WV 26306 PERSONAL IDENTIFICATION To obtain classifiable fingerprints 1. Use printer's ink. 2 Distribute ink evenly on inking slab 3. Wash and dry lingers thoroughly 4. Roll fingers from nail to nail, and avoid allowing lingers to shp. 5. Be sure impressions are recorded in correct order. 6. Notate in the appropriate linger blocks if applicant is missing one or more lingers for any reason. II not missing. all ten impressions must be provided with scars and deformities notated. 7. If some physical condition makes it impossible to obtain perfect impressions, submit the best that can be obtained 8. Examine the completed prints to see if they can be classified. bearing in mind the following: Most fingerprints fall into the patterns shown below Other patterns occur tnirequently and are not shown here FD-353 Personal Identification Privacy Act Statement Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes. State statutes pursuant to Pub.L. 92-544, Presidential Executive Orders, and federal PASTE regulations. Providing your fingerprints and associated information is voluntary: however, failure to do so may affect completion or approval of your application. PHOTO HERE Principal Purpose: Certain determinations, such as employment, licensing, and (OPTIONAL) security clearances. may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI's Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained. your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated informatiorVbiometrics are retained in NGI, your information may be disclosed pursuant to your consent. and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment. contracting, licensing, security clearances, and other suitable determinations: local, state, tribal, or federal law enforcement agencies: criminal justice agencies: and agencies responsible for national security or public safety FD-353 (Rev. 9-9-13) U.S. GOVERNMENT PUBLISHING OFFICE:OW.02017 11:5138 EFTA01699749 r PERSONAL IDENTIFICATION EE REVERSE SIDE FOR FukTHER iNSTRuC - IONS LAST NAME NAM INFORMATION IN BLACK FIRST NAME MCDI NAE/I rd LEAVE CLANK : FD-3.43(Ret 94131 SIGNATURE Of IERSON FINGERPRINTED FINGERPRINTS SUMAITTED BY A't OF OREN DOB RESCENCE OF PERSON FINGERPREITED Akre) 0e As F W N71 140 G BLN LP DATE FIAGERPRIICE0 sot RACE "GT ATSI EYES MAR RACE a SETH ROB Pia NOTIFIED N CASE CF ELERGENCY LEAVE BLANK WAG AlEsai ISCiAnTY ADDEESS IESCELIAPEOUS NO Non -Federal Confidential Screening FAEGERPRINTED BY REF SCARS AND BERES LZIT rocinFINCERIVAAEN EINIAATECOvrAy R Tit*. MOTT FODA CNCEffitt TAKEN SAAA.TAASOutte EFTA01699750  FEDERAL BUREAU OF INVESTIGATION UNITED STATES DEPARTMENT OF JUSTICE CRIMINAL JUSTICE INFORMATION SERVICES DIVISION, CLARKSBURG, WV 26306 PERSONAL IDENTIFICATION To obtain classifiable fingerprints 1. Use printers ink. 2. Distribute ink evenly on inking slab 3. Wash and dry fingers thoroughly. 4. Roll fingers from nail to nail. and avoid allowing fingers to slip. 5. Bo sure impressions are recorded in correct order. 6. Notate in the appropriate finger blocks if applicant is missing one or more fingers for any reason. II not missing, all ten impressions must be provided with scars and deformities notated. 7. If some physical condition makes it impossible to obtain perfect impressions. submit the best that can be obtained. B. Examine the completed prints to see if they can be classified. bearing in mind the following: Most fingerprints fall into the patterns shown below Other patterns occur infrequentty and are not shown here FD-353 Personal Identification Privacy Act Statement Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub.L. 92-544. Presidential Executive Orders. and federal PASTE regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. PHOTO HERE Principal Purpose: Certain determinations, such as employment. licensing, and (OPTIONAL) security clearances. may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of Comparing your fingerprints to other fingerprints in the FBI's Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and. while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI. your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register. including the Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine uses include. but are not limited to, disclosures to: employing, govemmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitable determinations: local, state. tribal. or federal law enforcement agencies: criminal justice agencies: and agencies responsible for national security or public safety FD-3.43 (Rev. 9-9-i3) U.B. GOVERNMENT PUBLISHING OFFICE:OB/244017 I 1:53.38 EFTA01699751 I PERSONAL IDENTIFICATION SEE REVERSE SCE FOR FURTHER INSTRUCTIONS F0-353(R•494471 I LIST."( NAM ALL INFORMATION IN BLACK FIRST WAIF MICC“ AM FBI LEAVE BLANK IGNATURE OF PERSON FINGERPRPin0 F RPRINTS Su/Uri-ED Iv DATE Of BOTH BOB REYLENCE CF PERSON FIHGERPRNTEO ma. O., New F W N71 140 G BLN LP DATE IlsGERPRIN'E0 x I RAC At, Ens PIACE BM). ROB TO CE NOTFIED IN CASE EN£RGENC 'LOAF SOCI.LL fECWITv LEAVE BLANK ANSIXESS CUSS Et LAREOUS NO Non -Federal Confidential Screening FIPItINTED SCARS Ax. an ran r inKCIISTAXEm SikOATANCOJS0' R TtiWO EFTA01699752  FEDERAL BUREAU OF INVESTIGATION UNITED STATES DEPARTMENT OF JUSTICE CRIMINAL JUSTICE INFORMATION SERVICES DIVISION. CLARKSBURG, WV 26306 PERSONAL IDENTIFICATION To obtain classifiable fingerprints 1 Use printer's ink 2. Distribute ink evenly on inking slab 3. Wash and dry fingers thoroughly 0 Roll fingers from nail to nail, and avoid allowing fingers to slip. 5. Ete sure impressions are recorded in correct order 6. Notate in the appropriate finger blocks if applicant is missing one or more fingers for any reason. If not missing. all ten impressions must be provided with scars and deformities notated 7 If some physical condition makes ❑ impossible to obtain perfect impressions. submit the best that can be obtained 8 Examine the completed prints to see if they can be classified. bearing in mind the following. Most fingerprints fall into the patterns shown below Other patterns occur infrequently and are not shown here FD-353 Personal Identification Privacy Act Statement Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub.L. 92-544. Presidential Executive Orders, and federal PASTE regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. PHOTO HERE Principal Purpose: Certain determinations, such as employment, licensing, and (OPTIONAL) security clearances, may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI's Next Generation Identification (NGI) system or its successor systems (including civil. criminal, and latent fingerprint repositories) or other available records of the employing investigating. or otherwise responsible agency. The FBI may retain your fingerprints and associated informationlbiometrics in NCI after the completion of this application and. while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, and other suitable determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies: and agencies responsible for national security or public safety Ft)-353 (Rev. 9-9-13) U.S. GOVERNMENT PUBLISHING OFFICE:0121/2017 11:5138 EFTA01699753 I PERSONAL IDENTIFICATION '_ EE REVERSE SIDE FOR FURTHER INSTRUCTIONS FP-353 (Rev 94431 LAST NYE NAM INFORMATIONIABLACK FIRST NAME MCGEE NAPE rg LEAVE BLANK MATURE OF PERSON MGM:PROOFS MIGERPRINTS SLORTTED BY DA OF EIRl DO: PC OF PERSON FINGERMINTED ee.. 0 V... P M N71 140 G BLN LP DATE FINGERPRINTED RACE NOT MGT EYES NAN PUCE OF ORM RCS PEIMVOTIFED N CASE OF MERGERS War LEAVE BLANK SOME S MERRY NO ADORE SS ELLANEOVS NO Non-Poderal Confidential Ccroening I'm:ER/MINTED BY EF SCARS MD MARKS EFTA01699754  FEDERAL BUREAU OF INVESTIGATION UNITED STATES DEPARTMENT OF JUSTICE CRIMINAL JUSTICE INFORMATION SERVICES DIVISION, CLARKSBURG, WV 26306 PERSONAL IDENTIFICATION To obtain classifiable fingerer 1. Use printer's ink. 2. Distribute ink evenly on inking slab 3. Wash and dry fingers thoroughly. 4. Roll ringers from nail to nail, and avoid allowing fingers to slip. 5. Be sure impressions are recorded in correct order. 6. Notate in the appropriate finger blocks if applicant is missing one or more fingers for any reason. If not missing, all ten impressions must be provided with scars and deformities notated 7. II some physical condition makes it impossible to obtain period impressions, submit the best that can be obtained 8. Examine the completed prints to see if they can be classified. bearing in mind the following Most fingerprints fall into the patterns shown below Other patterns occur infrequently and are not slytian here FD-353 Personal Identification Privacy Act Statement Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your applicafion, supplemental authorities include Federal statutes. State statutes pursuant to Pub.L. 92-544. Presidential Executive Orders, and federal PASTE regulations. Providing your fingerprints and associated information is voluntary: however, failure to do so may affect completion or approval of your application. PHOTO HERE Principal Purpose: Certain determinations, such as employment. licensing, and (OPTIONAL) security clearances. may be predicated on fingerprint-based background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI's Next Generation Identification (NGI) system or its successor systems (including civil. criminal, and latent fingerprint repositories) or other available records of the employing investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometncs are retained in NGI. your information may be disclosed pursuant to your consent. and may be disclosed without your consent as permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine uses include. but are not limited to. disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting. licensing, security clearances, and other suitable determinations: local, state, tribal, or federal law enforcement agencies: criminal justice agencies: and agencies responsible for national security or public safety FD-353 (Rev. 9-9-13) U.S. GOVERNMENT PUBLISHING OFFICE:Orta4/2017 liStge EFTA01699755  Attachment A CERTIFICATION FOR CONTINUED PRESENCE BY REQUESTING LAW ENFORCEMENT AGENCY TO: Unit Chief Parole and Law Enforcement Programs Unit Homeland Security Investigations U.S. Immigration and Customs Enforcement FROM: SAC FBI, New York Field Office RE: Request for Continued Presence for: SAC of the FBI New York Field Office concur in this request and certify, in accordance with the Department of Homeland Security (DHS)'s procedures for Continued Presence, that: 1. The justification and information concerning the request for Continued Presence are accurate and complete. 2. Documentation is attached certifying that the alien is a victim of a severe form of trafficking and may be a potential witness to that trafficking. 3. Name checks have been completed in the principle law enforcement databases on the person named in the request (National Crime Information Center and any other databases available) and, as appropriate, information from foreign law enforcement agencies. Criminal history check results based on fingerprints have been received and any identification issues resolved. [For. the.FBI: Coordination.has also been effected with appropriate member agencies of theintelligence Community.' 4. Copies of all database screens on the person named above, including negative responses, have been identified and forwarded to U.S. Immigration and Customs Enforcement, Homeland Security Investigations, Parole and Law Enforcement Programs Unit. 5. No promises have been made to the Victim that he or she will remain in the United States beyond the authorized period of Continued Presence. 6. An active investigation is underway by a law enforcement agency that requires the assistance of this subject. Certification for Continued Presence by Requesting Law Enforcement Agency FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE EFTA01699756 Signature [of Authorizing Official] Date Printed Name [of Authorizing Official] Title [of Authorizing Official] Certification for Continued Presence by Requesting Law Enforcement Agency FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE EFTA01699757  DEPARTMENT OF HOMELAND SECURITY U.S. Immigration and Customs Enforcement REQUEST FOR CONTINUED PRESENCE N.3:7 1bartA: InforatatiOnon'theitiopm. -.72.44t''> ;a14cir iCPIAC:' 1. Name: (Last) (First) (Middle) 2. Date of Birth (mo., day, yr.) 3. Country of Birth 4. Country of Citizenship 6. Allas(es) 6. Gender (check one) 7. Alien Number (A#) Male J Female A 8. Passport Number 9. Country of Issuance 10. Expiration Date (mo., day, yr.) 08/04/2020 & 05/14/2025 11. Social Security Number iiPartataitoguntifIgiaStieSO: 'Note: This information must be completed in order to receive consideration. 1. Lead Case Agent: 2. Daytime telephone number 3. Fax number (First, Last) (include area code) Ext 2. Case Agent where the Victim resides (if the Victim resides In a Jurisdiction other than that of the Lead Case Agent): (First, Last) 2. Daytime telephone number 3. Fax number (include area code) Ext SupplementalInformation: Requesting Agency: Federal Bureau of Investigation Group Supervisor's name (First, Last) Daytime telephone number (includingarea code) ext. Fax number Victim-Witness Specialiat's/Coordlnator's name (First, Last) Daytime telephone number (Including area code) ext. Fax number Request.for Continued Presence FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE ICE Form 73-031 (4/11) Page 1 of 4 EFTA01699758 *Note: Please complete allinformation below. 1. Is the Victim currently in.the United States? El Yes O No 2. The Victim's current immigration status: In the U.S. on an E-2 Visa 3. is the Victim requesting Continued Presence based upon a pending,civil action under 18 U.S.C. § 1595? 0 Yes 0 No If yes, provide details of where and when the civil action was filed, and the status of the civil action. 4. Has the Victim ever been deported/presently under deportation proceedings? 0 Yes Ej No (if yes, where and when) City, State: 5. When did the Victim enter the United States? 1st Entry 09/0145 6. Through which Port of Entry did the Victim enter the United States? New York, New York 7. How did the Victim enter the United States? Flight oi34/0 5,1* -00,09;**000:00.111M011-0411W Please answer each question as completely as.possible (Attach additional sheet(s), ifnecessary.) 1. Significance and value of the Victim to this case: (please provide a brief explanation ofhow the Victim meets the definition of "severe forin of trafftking" under section 103(8), Victims of Trafficking end Violence Protection Act of 2000, Pub. L. No. 106-388) See attached sheet. 2. The Victim's criminal involvement in this or any other case: (Please attach or describe criminal and/or arrest record listing ALL criminal convictions.) No criminal convictions. 3. Risk the Victim presents to public safety and/or to national security (i.e., has the alien ever engaged in a terrorist act, supported terrorist activities, or is a member of a known terrorist group? If so, explain.) List and explain proposed security precautions if necessary: (Attach copy ofrisk assessment report) No risk to public safety or national security 4. Financial responsibility for the Victim: (Please explain mannerin which the Victim's living expenses will be met.) is requesting employment authorization to work in the United States. 5. Acquaintance/Relatives in the United States: (Please include name(s), relationship, and current location, i.e., city and state; attach additional sheet(s), ifnecessary.) No relatives live in the United States. Request for Continued Presence FOR OFFICIAL USE ONLY / LAW ENFORCEMENT SENSITIVE ICE Form 73-031 (4/11) Page 2 of 4 EFTA01699759 6. Is employment authorization requested? E3 Yes O No (If yes, please attach completed U.S. Citizenship and immigration Services FORM 1-765; Application for Employment Authorization, and 1-102, Application for Replacement/Initial Nonimmigrant Arrival/Departure Document) Note: Information contained in question # 7-is not required for a victim to receive Continued Presence; however, this information is required fora victim to be certified to receive benefits from the Departinent of Health and Human Services (HHS), Office of RefugeeResettlement(ORR). A response to this question will assist HHS in ensuring the fast and efficient delivery of services to the Victim. Victims who have not attained 18 years of age do not need to be certified to receive benefits from HHS. 7. Is the Victim willing to assist in every reasonable way in the investigation and prosecution of a severe form of trafficking in persons? The term "investigation and prosecution" includes the: 1) identification of a person or persons who have committed severe forms of trafficking in persons; 2) location and apprehension of such persons; and 3) testimony at proceedings against such persons. 0 Yes O No 7404; tocation.whete the'Iiistintayinqtielde inWatktkitiiiOarIltigta Street Address City New York State NY *Initial requests are approved for a period of time determined on a case-by-case basis. ALL extensions for ContinuedPresence must be submitted to the ICE HSIHeadquarters Law Enforcement Parole Unit (LEPU). Any change in status is to be reportedto the requesting agency headquarters, which In turn willnotify LEPU. The requesting agency will also notify LEPU Immediately if the alien departs the United States. gfitatt:PrOectifitatiomotRiipOtitidiRiterli r t3fev Tlit-WsceggSylpiai As the requesting agency representative, I understand that, should thls ContinuedPresence be granted, it is MY responsibility to follow all of the policies andprocedures established by LEPU, including quarterly reporting, reporting changes in the Victim's status (Le., departure or change in status), and requesting applicable extensions ofapproved Continued Presence. -7(lo 2-0 na ure) Date) / Supervisory Special Agent me) 1 / I ES 2020 e gen gnature) (Date) / Special Agent (Print Name and Title) if the Victim resides outside the geographic area of the lead Case Agent, a monitoring agent must be designated in the appropriate jurisdiction. (Monitoring Group Supervisor's Signature) (Date) (Print Name and Title) (Monitoring Case Agent's Signature) (Date) (PrintRame and Title) Request for Continued Presence FOR OFFICIAL USE ONLY! LAW ENFORCEMENT SENSITIVE ICE Form 73-031 (4/11) Page 3 of 4 EFTA01699760 Privacy Act Statement Authority: 22 U.S.C. §§ 7102(8) and 7105(c)(3) authorize ICE to collect the information requested on this form. Purpose(s)