HOUSE_OVERSIGHT_021676.jpg

“ | APR-16-2010 13:13 FBI ICRC WINCHESTER VA P.004 +. " Federal Bureau of Investigatio@iivacy Waiver and Certification of rdontit AD Page 1 of 1 Compote. vlan, and.mall (original signature needed) 0S. Departmont of Justice Federal Bureau of Investigation i Privacy Walver and Certification of identity pute: Jeitzey E- Bpstein Attpas axed: ; cormadieen: 358 EL Brille Wav, Palm Beach, FL 33480 00 Date or Blrths 1/20/1953 Placo of mn_Kings County, New York Soda Socuity Numborfoptonuin OFO—44-3348 | COptionat: Prlor sddreasas, cigs 614, which may assiat Uia FOL In (ocating tho nsquested invormadion} Thereby walve my dghtao privacy, and } authorize tha PUI to releane any and all Information rateting to ma to: 4 (Rame, eddowse.& phone of ottormey of citer deslanes} v 53 P Plaza, Suite ms Boston MA O2Z116 -—- 617 227 3700 Undor penalty of 1 Chord am tho oa shove and undorsinnd thateny fwaificotion of thle slatemont ts punishable undar tho Provisiono 18, Untiod Stoths Code (U5.C.), Sucve (001 by 6 fite.of not mote then $10,000 of by Imartzonmenl of'not morg then tive years, of both: and thal raquastig xen te punishable under the provisions of Titty 6. U.6.C., Section 5526 (0(3) ov a cisdamannor ond by & fino of Dots; l 5/ g { | ' littp://foia.fbi.gov/waiver-him 12/29/2009 1. | TOTAL P.004 . fl ’ t HOUSE_OVERSIGHT_021676