EFTA00611209.pdf

ID:332 1000000616372 State of New York Division of Criminal Justice Services 80 South Swan St Albany, NY 12210 To: JEFFREY EPSTEIN 6100 RED HOOK QUARTERS, SUITE 83 ST THOMAS VI 00802 From: Sex Offender Registry Unit, NYS Division of Criminal Justice Services RE: Annual Address Verification Sex Offender Registry Annual Address Verification Form April 9, 2013 Offender ID: 33216 The Sex Offender Registration Act (SORA) requires you to review, update, and sign this Annual Address Verification Form and mail this form back to the Division of Criminal Justice Services within 10 days from receipt of this form. You must do this whether or not you have reported updated information to parole, probation or a law enforcement agency. If you attend, are enrolled at, reside at, or are employed at any institution of higher education, you must provide that information on this form. You must also report your Internet service provider(s), all screen names, all e-mail addresses and all other information listed on the form. If you are a level 2 or 3 sex offender, you must report the name and address of all employers. INSTRUCTIONS: • Review each line of information on this form carefully. • If you find any information that is incorrect or outdated, cross out incorrect or outdated information with a single line. • Enter any corrections or any new/additional information in the blank boxes provided. THIS FORM MUST BE SIGNED AND ALL PAGES RETURNED EVEN IF NONE OF THE INFORMATION HAS CHANGED. FAILURE TO RETURN ALL PAGES OF THIS FORM WITHIN 10 DAYS OF RECEIPT IS A FELONY AND MAY RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST. Please contact the Sex Offender Registry at 518-457-3167 with any questions about this form. OFFENDER INFORMATION LAST NAME FIRST NAME MIDDLE SSN EPSTEIN JEFFREY E 090443348 Mau carectians <— here OTHER NAMES EPSTEIN,JEFFREY EDWARD Enter any aliases, nick names or other names used in the following section. Page - 1 of 10 EFTA00611209 ID:"226 IIIIII~IIIIIIhtI~III If 1000000616372 PHYSICAL ATTRIBUTES BIRTHRATE HEIGHT WEIGHT HAIR EYES GLASSES 01 /20 /1953 600 180 Gray Blue Make creckans <- here SCARS/MARKS/TATTOOS Enter any other scars/marks/tattoos. PRIMARY ADDRESS Primary address is the address where you live most of the time. NUMBERISTREETIAPT CITY 1 6100 RED HOOK QUARTER$.$UITE B3 ST THOMAS make cariatuna <— here STATE ZIP COUNTY COUNTRY VI 00802 US Make cccrectorts <— here Phone eat this address: (561) 655- 7621 Enter phoce a correction here —, Name of College! University: Page •2 of 10 EFTA00611210 IO:33216 1000000616372 u SECONDARY ADDRESS Secondary Address is the address where you live some of the time. 1 NUMBER/STREET/APT CITY 9 E 71ST ST NEWYORK Mike COrteedons .— hene STATE ZIP COUNTY COUNTRY NY 100214102 New York US Maks CCereCtions <— here Phone SI at this address: Enter phone Si corroction he e --s Name of College! University: 2 NUMBER/STREET/APT CITY Make ccerecial, <— here STATE ZIP COUNTY COUNTRY FN Make OnTeCSOns a— hem Phone a at this address: Enter phone a erection here --s Name of College / University: 3 NUMBER/STREET/APT CITY 358 EL BRILLO WAY PALM BEACH Mace CareCtons <- hare STATE ZIP COUNTY COUNTRY FL 33480 US Make CamCcos .c.— here Phone # at this address: Enter phone Hoorrectim here —> Name of College I University. 4 NUMBER/STREET/APT CITY 49 ZORRO RANCH RD STANLEY Make Corrections .4— here STATE ZIP COUNTY COUNTRY NM 87056 US Make correctlOnS 4— here Phone ill at this address: Enter phone a correction here -> Name of College f University: Enter any additional Secondary Address in the following section NUMBER/STREET/APT CITY STATE ZIP COUNTY COUNTRY Enter phone a here --s If the above address is on :he campus of a College or University.enter its name 2 NUMBER/STREET/APT CITY STATE ZIP COUNTY COUNTRY Enter phone a here —> If the above address on the campus of a College or UnNerSity.enter its name Page - 3 of 10 EFTA00611211 Ilimump m."21 PO BOX ADDRESS PO Box Address is allowed if mail cannot be delivered to the primary address. PO Box Address must be approved by the Post Master and Law Enforcement. Enter any PO BOX Information in the following section 1 PO BOX CITY STATE ZIP COUNTY COUNTRY EMPLOYMENT INFORMATION I EMPLOYER'S NAME NUMBER/STREET/APT SOUTHERN TRUST COMPANY SOUTHERN TRUST COMPANY. 6100 RED HOOK OLMTERSBUITE S3 Make commons e.— hare CITY STATE ZIP COUNTY COUNTRY ST THOMAS VI 00602 US Make comnticos a- here Name of Codege / University Enter any additional em lo ment information in the follcwing section 1 EMPLOYER'S NAME NUMBER/STREET/APT CITY STATE ZIP COUNTY COUNTRY If the above address is on the campus of a College or UniverMy.enter its name 2 EMPLOYER'S NAME NUMBER/STREET/APT CITY STATE ZIP COUNTY COUNTRY If the above address is on the campus of a College or Universityenter its name HIGHER EDUCATION INFORMATION Higher education includes any 2 or 4 year colleges or any trade or vocational schools. Enter any additional education information in the following section 1 SCHOOL NAME NUMBER/STREET/APT CITY STATE ZIP COUNTY COUNTRY Dales of Attendanott. Employment or Enrollment From Date To Date Check one MI Ennaled II Employed . Attending 2 SCHOOL NAME NUMBER/STREET/APT CITY STATE ZIP COUNTY COUNTRY Dates of Anendanot Employment or Eno:0men: From Date To Date Check one • Enrolled 0 Employed ID Attending Page - a of 10 EFTA00611212 ID:"21 1000000616372 VEHICLE INFORMATION Information of any vehicle that you own or drive. YEAR MAKE MODEL COLOR LIC PLATE STATE 2010 Chevrolet Suburban Black FEIJ8826 NY Make corrections <- here 2006 Bentley Amage Black V752DS NY Make correetkme <— here 2000 Chevrolet Suburban Black CHX920 NM Make «tremens C— here 2007 Hummer Hummer II Black . CPK643 . . NM mete cenvehms <— nana 2005 Cadillac Escalade Black 0299GT FL Make correct:ma <— nere 2002 Mercedes-Benz SL500 Black C165SP FL Make CtereMans c— nee 2010 Chevrolet Suburban Black TED218 VI make =moan 4— here 2005 Cadillac Escalade Black TDJ142 VI make ttnections C.-. here 1999 N491GM NM Make =Imams c— here . 1974 N909JE FL Rieke MerectonS C— here 1968 N908JE VI Make corrections C— here 1968 2583TC VI Make corrections C— We 2008 2907TC VI make corrections C- here 2006 07307C VI make =octane a.— nem 2007 2909TC VI Make commas C- nere 2010 3499TC VI Make C0MOC.111 C.... here 2006 2908TC VI Make corrections <— here 1984 02597C VI Make corrections C— here 1999 2709TB VI Make tametOns C- net. 2012 Cadillac Escalade Black FTX3455 NY moo carvakevi Page - 5 of 10 4—here nAln 1:11...(4# oni u," EFTA00611213 Enter any additional vehicle information in the following section YEAR MAKE MODEL COLOR UC PLATE STATE DRIVER'S LICENSE INFORMATION DRIVER'S LICENSE NUMBER ISSUING STATE C000000029913 VI Make =sections <-- here Enter any additional driver's license information in the following section DRIVER'S LICENSE NUMBER INTERNET INFORMATION SERVICE PROVIDER SERVICE PROVIDER AT&T Make careebons .. . here FREE Make ectrectons 4".. her* ORANGE TELECOM Maw correcions COMCAST Make ccmo:00na e— here SPRINT Make corrections e— here TIME WARNER mem correcbons e— Sore FACEBOOK Mike caret-tans <— here PINTEREST Make corrections <-- here ISSUING STATE Page - 6 of 10 EFTA00611214 IRIIINE SCREEN NAME SCREEN NAME THEJEFFREYEPSTEINFOUNDATICN Make cc:reams <— here JEFFREYEPSTEIN Make canmons <— here JEFFREYEPSTEINORG Make turectons h nee THE JEFFREY EPSTEIN M FOUNDATION . . . Make s <—here JEFFREYEPSTEINFOUNDATION Make acme:ens <— Mee JEFFREY EPSTEIN Make correcaces <—hare JEFFREYEPSTEINI Make eterecnans c—here TWTTER JEFFREY_EPSTEIN Make Orreacm .c.... here JEFFREYEPSTEIN12 Maks Carreetem <— nen: JEFFREY Make CecreCiOna <— hen! JEFFREYEPSTEIN2 Make aCMCSOM <— bore Page - 7 of 10 EFTA00611215 II REILRIII EMAIL ADDRESS E-MAIL ADDRESS JEERROJECTigiYAHOO CQM Mika CWOXIMen a.— here JEEYACitaKMMEregad Make =matrons c hen, gLEYWATIONOKaMAILCOM a niC5361 FFFREYEPSTEIRORGraGMAIL CON Make CaTeCOMS .e.— hero Leff YEPST Ill BLaan Make carececos a— here Make Corrections .c... here Make caveats a.— here 180868SRSTEIN.US Make corrections <— hero Make corrections e— here Make cabana a— Nre WŽMUREERMPslEausvt COM Make ccerachans VAMV JEFFREYEPS1EIN,VVEEELY.COM Make CCCOCIMIS .c-- here Make =Mara <— here Make creations <— kare WANII.JEFFRFtErna Make tortectons 4—here MeLgEEREvEzsratslo Make CUTOCOOMI a— tote Make cerrecborts 4— NM C_OLUMOJADENTAI la Make earrecbcin <— here MBELE MIMI= Make cc:nova:a', <— here jEaREYOJEFFREY_EPSTEIN Oar Make orreatrOrte PagencSof 10 EFTA00611216 ID:33 1000000616372 — Enter any additional Internet information in the following section SERVICE PROVIDER SCREEN NAME EMAIL ADDRESS I CERTIFY THAT THE INFORMATION ON THIS FORM IS COMPLETE AND ACCURATE. I HAVE CROSSED OUT ALL INFORMATION THAT IS INCORRECT OR OUTDATED. I HAVE ADDED ALL CORRECTIONS AND ALL NEW INFORMATION. I UNDERSTAND THAT FAILING TO PROVIDE THIS INFORMATION OR PROVIDING FALSE INFORMATION IS A FELONY. Sex Offender's Signature Sex Offender's Name(print) Date THIS FORM MUST BE SIGNED AND ALL PAGES RETURNED EVEN IF NONE OF THE INFORMATION HAS CHANGED. FAILURE TO RETURN ALL PAGES OF THIS FORM WITHIN 10 DAYS OF RECEIPT IS A FELONY AND MAY RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST. Return to: Division of Criminal Justice Services - SOR 80 South Swan St Albany, NY 12210 Page -9 of 10 EFTA00611217 U! !l皿IIIlIIIIIIJI I U1 1 ! I IU tD:332 I 6 1000000615372 Michael C. Green Executive Deputy Commissioner New York State Division of Criminal Justice Services Notice of Important Document ENGLISH This is a 山lle-sensitive legal document. Failure to respond could result in crimin키 charges. If you need free translation, please call 518-457-3167. Thank you. Espafi이 Spanish' Este documento legal tiene fecha de vencimiento. La falta de respuesta puede resultar en una quereila penal. Si necesita una traducci6u gratuita, line al 518-457-3167. Muchas gracias. 筒休字 罰mptified Chinese 迭是m价要求限期回夏的法律文件0 不予回芟可能尋致被刑卒指控0 如 果悠需要免矗的鬪澤件 , 靖致屯 518-457-3167口澍澍0 KreyOl Ayisyen Haitian. Cre이e Sa a se you dokiman legal ki gen del pou w respekte. Si w pa reponn sa ka lakoz akizasyon krimin飢 Si w bezwen tra曲syon gra小, tanpri rele nan 518- 457-3167. Mesi. 1 It a liano Italian 11 presente e un documento legale urgente. La mancata risposta pu6 dar luogo a 山l procedimento penale. Per una traduzione gratuita, chiami II numero 518- 457-3167. Grate. 한국어 Korean 이것은 시간을 다투는 법적인 문건입니다 . 응답하지 앉는 경우 형사고발을 당할 수 있습니다 . 무료 번역이 필요하시면 , 518-457- 끄67 번으로 전화하십시오 . 감사합니다． Pyccici作i Russian 3To 王아）H1ZHieCKH甘 八아C)小1eirr, TP e6yioz파dl 6esoT月町ares臣Horo BHHMaHU月· I妃cBoeBpe八妃H표I,埴 OTBCT MO月化T UPHBeCTH IC flPCi1万只EJICHHfO yronoBHoro otDBHHeHHz. bcJIM B&M Hy)KHbI oecrlslatHLle yenyril nepeBo及a, IIO3BOHHTe 11O noMepy 518-457-3167. Cnacw6o. Pa倂 1 100110 EFTA00611218