EFTA00614942.pdf

T: DELSON INTERNATIONAL, INC. 33 West 19'h Street, 46 FL New York NY 10011 F=01. CERTIFICATION OF LAWRENCE DELSON The undersigned, Lawrence Delson, for and on behalf of the firm of George V. Delson Associates, accountants of Mr. Jeffrey Epstein during the years 2009, 2010, and 2011, hereby certifies that the firm of George V. Delson Associates prepared Department of the Treasury form TD F 90-22-1, Report of Foreign Bank and Financial Accounts, for Mr. Jeffrey Epstein for the year ended December 31, 2010. A true and correct copy of said Report as so prepared is attached hereto, redacting therefrom any account information other than information pertaining to Mr. Epstein's accounts at HSBC Private Bank SA in Geneva, Switzerland. As office manager of the firm, I personally supervised the preparation of said Report. In addition, I personally delivered the said Report to Mr. Epstein, witnessed him signing the same and subsequently caused the said Report to be deposited on June 30, 2011 with the United States Post Office for mailing to the Department of Treasury. George V. Delson, the sole owner of the firm George V. Delson Associates, died on February 22, 2012. The firm ceased to exist as of January 31, 2013. This certification is submitted both in my capacity as office manager of the said firm and as executor of the Estate of George V. Delson. IN WITNESS WHEREOF, the undersigned has signed this Certificate this 154 day of October, 2014. ce Delson Sworn to before me this 1m day of October, 2014 X4 1 ,K Itc 4arY:u 07aa ctiosesessiamaisillasilawe LESLEY IC GROFF Notary Publk • Sine of New York NO. 010R8285700 Welted In New York County ' My Consoitsion Expires Jul 8.2011 SrP•rererrrIP P"IP"."I EFTA00614942 COPY TD F 90-22.1 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS DO NOT Me with your Feint Tax Rearm cres n.1545101' 1 Moyer= Veen 2010 Amended O Filer information 7 Typ< FRt • gi pew. a WITem Idwelcedi Meter 090443348 II Ma loam u.S.11millalin Plumber temples Il••• • Dcannodurn d❑Onliblel • 010107y • Ceir — On* 770.v to efcrt.CtiOn CertehIedek7 %Nem 3 Is dot I•03••333 anal phew. pea • Cray War I InCe•duar•Date SSW 14,1O71ffer 1/20/1953 Ise lite a. Ofloneseen Nam EPSTEIN 7 rafts JEFFREY E. • Wear fill I Padwa pater, em IS ddresel w Sib Plon•O 6100 Red Book Qtr Ste 3B 1e ear St Thorn VI 00002 13 may US 14 0••• M Id• les • Sawa es In 25 a a temebtateetar/ II 'Stace Urns oadot•faseads. drYse it chlekad, •• V cmal•l• Me •• ion ea ali 7•0•48•13/1 30•1•0•71) XI re .81 Information on Financial Account(s) Owned Separately IS asps rad or an Oat e•ledw yaw muds., It Tyft atenffig Is- I LI *maw • UMW /Mot WO WINN 17 Rani /Owes buisdat r dia as anti a MS is seam nod= es all desonatlan cry II Mae Attienfluati. Snot 3•04 Mote) •• foonelallotida a vekb meal Is SW swa.O hams DAPONISOxle. Odom a Conn itibatala 64 Mar Troot net nisloq• pininVe wand. If ors escorgrrn SISYNO—ck lei CA tt U:k" File turns form with: U.S. Depstrxrrenl of the wrote% P.o. sox mat Deo* MI 482124421 This form staid be used to report a financial interest In. signalise authority. or other authority ant one or more financial accouls *WWI countries. n mowed by the Department ol the Treaury Reulations 31 CFR 1010.150 Rotreerly 31 CFR 103.24). No raga is required Os aggregate value o' the accounts nal exceed 510.000. Ste Instructions For DeOrdllons. PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE Pursuant to tla MCILIMMOIlS a/ Atli law 93-579 (Privacy Act el WC Sias is Web/ van tat he Shot* to collect Worst. on F 90.22.1 in accordance with S UW 5S2a (e) is Public law 91401 31 USC 5314; 5 USC 301; 31 CFR 1010.350 (formerly 31 CFR 10324). The principal pupae for collect/ the information b to sass maintenance of reports where such reports a records have a high degree of in ainisel, in rx . rep abwy oweshgations or proceedings. The information co lietied may be provided to those officers and employees of any constituent wet of the Department of the Treasiey wog have • need Sy Oa records in the performance algae rates. The records may be referred to any other department a agency of the United States upon the reguest of the head of such department or agency Inuse in a criminal, tax. or regulatory investigation or proceeding. The information collected rnaverso be provided to appropriate state, lone, and torsion taw enforcement and regulatory personnel In the performance of thou official &hes. Ougastife of this thformation is mandatory. Civil and elertflai penalties, including in certain circumstances a fine of not awe than 1500,030 and imprisonment or net mare than five years, are provided for Niers to lute • (Wail. supply Wormabons and for Sling a false or kauduthnt report. Disclosure of the Social Security number is mandatory. The writnty. to collect is 31 CFR 1010350 (formerly 31 CFR 10324). The Social Seemly weber will be Used ts a means to identify the rialvidual who files to report The estimated average burden associated with this collecUon of information is 20 eremites pen a record keeper. depend rig on id indivual circumstances. Comments regarding the tort of this estimate. and Ion reducing Oa burden should be directed to the Internal Revenue SaMoa, Bank Secrecy Ad Policy. 5003 Ellin Road C-3242. m MD 20706. FCCIDOn OMNI I PPM 1/051 Form TO F 113-22.1 (Rev 3-2011) EFTA00614943 KoMk(Condinvd—InftmnadononFlnanch4Accounks)Ovoned5eparatedv Complete a Separate Block for Each Account Owned Separately This side can be copied as many limes as necessary in oar to provide Inconraon on al actoals. t a $4 ea 414•444 Idaltanen ass nima Una, MSS Oats 2010 Fana Meakain, tato a.rIMI 090443348 teem witos.c.04 dot* ea peg sone 990,_733. 17 as nma aka i• was crawl lea HSBC Private Bank SA 17 awl sea So craw,. 1207997 ZO 00 Geneva 3 is manta as a acme( Sa carat per awn 3,802,298. 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