Scanned Document Collection ta : ‘ D os a U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS 0¥" "=~. BURDEN 43 iN 498-202 Ailentior’ Read WARNING on page 1 of insructons >_> Ploase select the document(s} for which you are applying: (BLU. Passport Book. C). U.S. Palisport Ca Both weneec ath ; + T1545 7872 Box ondarc cus ya! Me thee tet a ; Oe Cle oe OTS Coss MAXWELL Exp. First GHISLAINE j NOELLE ‘2. Date of Birth (mevtitiyyyy) 2 Sox 3 Puace of birth Ee FO . P| Arment Comeany, Suh Usit Ruling, Floo i Care Of or Attention if yopicable (eg 9 Care Of - Jane Doe, Apt # 100) Zi Dose Covniry foutre fe Unis States a 10, Passport Book and/or Passport Card Information ‘Your name as fsiec on your most recent passport Hook andlor passport card GHISLAINE NOELLE MAXWELL issue dite (imemtkstyyyy) 12/04/2002 teem date (mevees/yyyy) SF Conge bi loematiin Crm ate i rot is Oot than last aae=907 Dok o* nesaport card Care ® tees ace of Nove Change i) State) Ome unde vy) FOR ISSUING OFFICE ONLY ( Marsage Certican Dane of Meagan Pigcoacos ] Cort Oncter Date FieetCour Page | of 4 https://cedi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020 EFTA00037662

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Scanned Document Collection P 2 of 4 age 2 of ¢ ‘Name of Applicant (Last, first 6 Mice) Date of Birth ynenektyyyy) MAXWELL, GHISLAINE NOELLE | 12 —_ 13. Ko Cole 14 Tye Cole 18. ceuoation 16, Employer or Schoo! ‘appicanie) 5ft. Bin. Brown Brown CONSULTAN SELF EMPLOYED 17 Additional Contact rivone Nuabers 48, Permanent Address: if P O, Box Fated under Maiing Address ge # resitence is ditferent from Mading Ackiress StreevRFD # or URB (No P.O. Bow) not Ireveiing with you to be contacted in the event af an emergency Steet or P.O. Bax ApartmantiUrwt 419. Emergency Contact - Provide the informadon of @ person PR oe hn omer cr ae lip. a 20. Travel Plans : Date of Tee (mevextyyyy! Duration of Trip Countries to be visited i 04/12/2012 2 WEEKS FRANCE aN t Fa if | i STOP! YOU HAVE COMPLETED YOUR APPLICATION BE SURE TO SIGN AND DATE PAGE ONE ONAN * DS 82 B 12 20102 * 05-82 12-2010 Page 2 of 2 https://cedi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41..._ 2/24/2020 EFTA00037663

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Scanned Document Collection Page 3 of 4 Letter of Authorization To: The US Passport Office Dear Sir/Madam: oa |, GWSLMWE MAKweLW hereby authorize ae Passport Rush, LLC. to submit my passport and collect it when issued The following visas are required prior to my departure: cueorbuy ( | Thank you for your prompt wa = S of / minor applicant For my son/daugnter https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020 EFTA00037664

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Scanned Document Collection Page 4 of 4 https://cedi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020 EFTA00037665