EFTA00313270.pdf

Registration No: 567563 Person Number: 73274 FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM Agency Name: Palm Beach County SO "*" Note: Your next ReRegistration month is January of 2014'"" Registration For: July 2013 •SEXUAL OFFENDER Reason For Registration O Initial Registration O Scheduled ReRegistration O information Update O Early/Late ReRegistration Registrant Information Name: (Firm Mdd'e Last. Soho) 'Disclosure of your Social Security Number (SSN) is mandatory pursuant CO Florida law. sections 775.21. 943.0435, 944.607. Eratellt. F.S., and federal Ism 42 USC 16901, seq. Use of your SSN is for the papaws or deadhead:et FDLE may share the infon'mtion with the other ireenciss for the same outpost. JEFFREY E EPSTEIN •SSN: DOB: Race: White Sex: Male FL DL or ID Card #: Height: 6' 00 • Weight. 180 lbs Hair. Place of Birth: United States Of America (use) Currently on ProbalionParole: 0 No O Yes Probation Type: O State O Federal O County State City Officer Name: Grey Eyes: Blue Phone: ( ) Officer Name: Phone: ( ) Officer Name: Phone: ( ) County Out of State Travel Information (Complete if permanent, temporary, or transient address is out of state) O Permanently leaving Florida to establish a residence In another state O Temporarily leaving Florida to visit another state O Moving from another state to permanently establish a residence In Florida O Visiting from another state and establishing a temporary address in Florida El Other (please describe): Date of Departure: Date of Arrivat Mr. Epstein came in to do his scheduled registration and wil be leaving going back to his permanent address tomorrow 07/21Mt3. Previous Permanent Address Current Permanent Address 6100 Red Hook Quarters Ste B3 (Address Une 1) (Address Line 1) Little St James Islands (Address Une 2) (Address Line 2) St Thomas VI 00802 (City) County: (State) (DP) End Deis: (City) (Slate) Rim County: St Thomas Stan Date: 07/1912010 I do NOT have a permanent address at this time. Pees I of 6 201247-25 34028 PM EFTA00313270 Registration No: 567563 Person Number: 73274 Temporary Addresses 0 I de NOT have • temporary address Please note: The registrant has reported additions' temporary addresses not displayed here. 1. 356 El Grillo Way Palm Beach FL 33480-4730 (Street Address) County: Palm Beach (City) ' Dates you will be at this add/ass From: (Slaw) 07126/2012 Rip) To: 2. 9 E 71st St New York NY r( e) 10021-4102 (Street Address) County New York (City) Dales you will be at this address: ' From: (73/47) To: 3. (State) (Zip) To: (Street Address) County (City) Dates you will be at this address: From: Transient Addresses 0 I do NOT have • transient address 1. (Street Address or location) County: (City) Dates you will be at this address: ' From: (Stale) (Zip) To: 2. (Street Address or location) County: (City) Dates you will be at this address: From: (State) Rio To: 3. (Street Address or location) County: (City) Dates you will be at this address: From (State) (20) To: Employment Want currently unemployed. 1. Employer. Address: County: Financial Trust Company Occupation: Owner Start Date: 07/26/2012 6100 Red Hook Quarter Ste 83 St Thomas VI 00802 (Street Address) Saint Thomas (qty) i Contact Person: (Stale) (re) 2. Employer Address: County: Occupation: Start Date: i (Street Address) (OM Contact Person: (Stew) (Dal 3. Employer Address: County: Occupation: Start Date: (Street Address) (City) Contact Person: (State) (2e) Page 2 d6 20110745 3-4(t.28 Phi EFTA00313271 Registration No: 567563 Person Number: 73274 Mailing Address O Same as Permanent O Same as Temporary Phone Numbers Please note The registrant has reported additional phones not displayed here O I do NOT have or use any home or mobile phone numbers 9 E 71st St 1. 2. 3. 4. 5. Phone Number: Phone Type: Horne (Ackkess Line 1) Mobile (Address Lie 2) New York NY 10021 Fax (Clly) County: New York (Slato) (29) End Dew Work _ Fax Vehicles K I do NOT own or use a vehicle, RV, trailer or mobile home. Please note, The registrant has repelled additional vehicles not displayed here 1. 2013 Ford Expedition Black Truck (Year) (License Tag JO (Make) NM This vehicle is: (model) ID NOT used as a residence (C.okir/Color Scheme) O Used as a residence (Vehicle Typo) (Slate) 2. 2013 Dodge Caravan Black Auto (Year) (License Tee 10) (Make) VI This vehicle is: (Model) O NOT used as a residence (Color/Color Scheme) a Used as a residence (Vehicle Type) (State) 3. 2008 Land Rover Range Rover Black Truck (Year) (License Tag //) (Make) NM This vehicle Is: (Mode) a NOT used as a residence (Color/Color Scheme) O Used as a residence (Vehlde Type) (State) 4. 2012 Cadillac Other Black Truck (Year) (Make) NY This vehicle is (Model) O NOT used as a residence (Color/Color Scheme) O Used as a residence (Vehicle Type) (license Tag N) (State) Vessels D I do NOT own a vessel or houseboat. Please nobs: The registrant has reported additional vessels not displayed hens 1. 1968 Other White Big N (Year) Yes (Vessel Type) This vessel is (Cora/Color Scheme) rac NOT used as a residence (Name of Vessel) O Used as a residence (Registration I) 2. 2011 Other White (Year) Yes (Vessel Type) This vessel is: (ColoaCeior Scheme) M NOT used as a residence (Name of Vessel) O Used as a residence (Registraoon 5) 3. 2011 Other White (Year) yea (Vessel Type) This vessel is: (Color/Coke Scheme) 0% NOT used as a residence (Name of Vessel) E l l Used as a residence (Recirmition a) 4. 1999 Other White Nana (Year) 788 (Vessel Type) This vessel IS (Co/or/Color Scheme) x NOT used es a residence 0 (Name olVesalil) O Used as a residence (Registration l/) Page 3 of V13-07.2631414e28 PM EFTA00313272 Registration No: 567563 Person Number: 73274 Campus Activity E I am NOT s student employee, or volunteer at a university or institution of higher learning. 1. D Student O Employee K v„,„n,cor University/School Name' Slag Date Erd Date Campus. Address: (Street Address) County: Employer. (City) Contact: (State) (Zip) Start Date: End Date: 2. MI Student O Employee O Voiumeer University/School Name: Campus: Address (Street Address) County Employer (City) Contact: (Stale) (Zip) 3. K Student O E mph:not O Volunteer University/School Name. Start Date: End Date: Campus: Address. (Street Address) County Employer. (City) Contact: . (State) (10) Cyber Communication Accounts K I do NOT use any email addr or Instant blesses • screen names. Please rote The registrant has repont.4 additional online accounts not displayed hem Email Addresses 1. metantftessage Screen Names Name: Provider. 1. 2. 2. 3. 3. 4. jeeprMett@yah0o corn 4. 5. 5. Adjudication Information Date Adjudicated Crime Location of Adjudication/Conviction Victim Information 1. O Minor O Adult Gender 2. (County) ' (Stale) O mina O Adult Gender. 3. (County) . (State) O Minor O mull Gender: 4. (County) (State) O moor O Adult Gender: (County) (State) Were you or ere you subject to registration or community notification in another state? CI yes 0 No If Yes. in what state? Page 4 of 6 2013-0?-25 3.40-M PM EFTA00313273 Registration No: 567563 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 985.4815) I understand that I am required by law to abide by the following: "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, vacation, business, or personal travel destinations in or out of this state, for a period of 5 or more days in the aggregate during any calendar year and which is not the person's permanent address or, for a person whose permanent residence is not in this state, a place where the person is employed, practices a 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 more days in the aggregate during a calendar year and which is not the person's permanent or temporary address. The term includes, but is not limited to, a place where the person sleeps or seeks shelter and a location that has no specific street address. FAILURE TO COMPLY WITH ANY OF THE FOLLOWING REQUIREMENTS IS A FELONY OF THE THIRD DEGREE (UNLESS OTHERWISE NOTED). 1. I MUST report Mignon to the local Sheriffs Office within 48 hours of establishing or maintaining a residence in this state, within 48 hours of release from custody and/or supervision of the Department of Corrections (DOC), the Department of Children and Family Services (DCFS), or the Department of Juvenile Justice (DJJ), or in the county of conviction within 48 hours of conviction if not under custody and/or supervision of DOC to register my temporary, transient, or permanent address and other information specified in statute. {F.S. 943.0435(2)(a); 775.21(6)(e)11. 2. At initial registration, I MUST provide the following information to the department: name, date of birth, social security number, race, sex, height, weight, hair and eye color, photograph, home telephone number and any cellular telephone number, any electronic mail address and any instant message name required to be provided pursuant to paragraph s. 943.0435(4)(d) F.S. or s. 775.21(6)(g)4 F.S., address of legal residence, address of any current temporary residence, if no permanent or temporary residence, any transient residence within the state, dates of any current or known future temporary residence within the state or out of state, occupation and place of employment, date and place of each conviction, fingerprints, and a brief description of the crime or crimes committed. (F.S. 943.0435(2)(b); 775.21(6)(a)11. 3. Within 48 hours after the initial report required as stated in requirement #2 above, I MUST report in person to the driver's license office of the Department of Highway Safety and Motor Vehicles (DHSMV) and provide proof of initial registration as a sexual offender or predator to secure or renew a valid Florida driver's license or identification card displaying one of the following designations: "775.21, F.S." or "943.0435, F.S.", unless a driver's license or identification card with such designation was previously secured or updated. The sexual offender shall submit to the taking of a photograph for use by the department in maintaining current records of sexual offenders/predators. (F.S. 943.0435(3); 775.21(6)(0). 4. Each time my driver's license or identification card is subject to renewal, or within 48 hours after any change in my permanent, temporary, or transient residence or change in name made by marriage or other legal process, I MUST report in person to a driver's license office to update my driver's license or identification card and ensure that the driver's license or identification card displays the designations as identified in requirement #3. (F.S. 943.0435(4)(a); 775.21(6)(9)1}. 5. If I am enrolled, employed or carrying on a vocation at an institution of higher education in Florida, I MUST provide the name, address and county of each institution including each campus, enrollment or employment status, including each change in enrollment or employment status, i.e. commencement or termination, In person at the Sheriffs Office; OR, for a sexual offender on supervision with the Florida DOC or DJJ, this information must be reported to the sexual offenders probation officer, within 48 hours after any change in status. (F.S. 943.0435(2)(b)2; 775.21(6)(a)1.b}. 6. I MUST report any electronic mail address or instant message name, prior to using such, during registration/reregistration or by providing all updates through the online system maintained by the Florida Department of Law Enforcement. {F.S. 943.0435(4)(d); 775.21(6)(9)4). 7. If I vacate a permanent, temporary, or transient residence, and do not have another permanent, temporary, or transient residence, I MUST report Ingerson to the Sheriffs Office in the county where I am located within 48 hours. {F.S. 943.0435(4) (b); 775.21(6)(g)2}. 8. If I report that I have vacated a permanent, temporary, or transient residence and then remain at that residence, I MUST report in person to the Sheriff's Office where I reported vacating my residence. Failure to report this information is a felony of the second degree. {F.S. 943.0435(4Xc); 775.21(6)(g)3}. Per 5 of6 2klari,13:1428.111 EFTA00313274 Registration No: 567563 Person Number: 73274 9. I understand that my address will be verified by county, state or local law enforcement agencies. {F.S. 943.0435(6); 775.21(8)}. 10. If I intend on establishing a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida, I MUST report in person to the Sheriffs Office in the county of my current residence within 48 hours before the date that I intend to leave this state to establish residence in another state or jurisdiction. {F.S. 943.0435(7); 775.21(6)(0). 11. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida and later decide to remain in this state, I MUST report 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 is a felony in the second degree. {F.S. 943.0435(8); 775.21(6)(j)}. 12. I MUST report imams either twice a year (during the month of my birth and during the 6th month following my birth month) or four times &year (once during the month of my birth and every 3rd month thereafter), depending upon my offense/designation, to the Sheriffs Office in the county in which I reside or am otherwise located to reregister, unless otherwise notified by FDLE. All sexual predators, sexual offenders convicted for offenses specified in F.S 943.0435(14)(b), and juvenile sexual offenders required to register per F.S 943.0435(1)(a)1.d are required to reregister four times a year. All other sexual offenders are required to reregister twice a year. El AM REQUIRED TO REREGISTER TWO TIMES A YEAR; I MUST REREGISTER AS NOTED BELOW. (Pursuant to Sections 943.0435(14)(a), 944.607(13)(a), Florida Statutes} n I AM REQUIRED TO REREGISTER YEAR; I MUST REREGISTER AS NOTED {Pursuant to Sections 775.21(8)(a), 943.0435(14)(b), 944.607(13)(b), 985.4815 13)(a), Florida FOLIg TIMES A BELOW. Statutes) Month of Birth I must reregister in: Month of Birth I must reregister in: Month of Birth I must reregister In the months of: Month of Birth I must reregister 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 sta e, but work or attend school in Florida, I MUST register my work or school address as a temporary address within 48 hours by reporting in oerson to the local Sheriffs Office. {F.S. 943.0435(2); 775.21(6)(a)1b; 775.21(6) (e)1}. 14. 1 MUST respond to any address verification correspondence from FDLE within three weeks of the date of the correspondence. (F.S. 943.0435(14)(c)4; 775.21(10Xa)}. 15. If I am employed, carry on a vocation, am a student, or become a resident of another state, I am on notice that I may have a requirement to register under the laws of that state. 16. I MUST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(1)). PLEASE READ CAREFULLY REFORE SIGNING As a sexual predator (Florida Statute 775.21) or sexual offender (Florida Statute 943.0435, 944.607, or 985.4815), 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 0 REREGISTER EACH YEAR AT THE SHERIFFS OFFICE IN T THS OF January AND July. Registrant: Printed Name: JEFFREY E Witnessed by Reporting Officer. Date: 07/292013 Printed Name: Shenica • OFFICIAL DOCUMENT DO NOT DESTROY' ••••' NOTE: Your next ReRegIstratIon month Is January of 2014. ""• Page 6 of 6 Signature Required Date: 07125/2013 2013-07-25 140.29 Pod EFTA00313275