Scanned Document Collection Page | of 3 o> Cx oF a / /2 APPLICATION FOR A U.S. PASSPORT BY MAIL Attention: see WARNING on page two of instructions "ease select the document (or documents) for which you are applying: agra - ié «]U,S.\Passport’Book »[)U.SPasspornCatd he US pepagnrt cant ray one for wer trney By Wend ow ane betmngn ter Urited Shines “ate 1. Name MAXWELL First & Middle GHISLAINE NOELLE 3. Sex 4. Place of Birth (Oty & State or City & Country as it 6 presently known) (_]m[x]r 6. Mailing Address: Street/RFD # or PO. Box or unit # Oty PS In Care Of of Country, f applicable 3 WS a. = ere C tit Ci ne (Maden, Previous Marriage, Legal Name Change)? If yes, please complete. (Atach additional pages ¥ needed) 10, Passport Book or Passport Card Your name as listed on your most recent passport or passport card = C_ “Th iP Sa 4 Issue date (mmydd/yyyy) 12/04/2002 11. Name Change Information - Complete if name is different thar) last passport book or passport card Place of Name Change (Oty/State) Date (mm/dd/yy, CD Changed by Marriage Q ] Geeged by Court Order GHISLAINE NOELLE MAXWELL 77 Most recent passport book or passport card 1 Oectare under penalty of penury af of the foloveng. Coren or non-citizen national of the United States and have net, snce acquiring U.S. Cozership or naboruiity, performed ary of the acts “Acts or Conditons” oni the reverse side of this applicaton (unless explanatory statement is attached); Z)the statements made on the a EE, not knowingly and wilfully made faise statements or incuded false Gocuments support of this application; 4)the photograph ewe read and Understood the warrang On page two of the instruchons 20 the eppecation fem oo aamaaaaaammm (0 Marriage Certificate Date of Marriage/Piace Issued: DD Court Order Date Filed/Court OD Other 0 Attached ‘cedi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=42994A0... 2/24/2020 EFTA00151152

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Scanned Document Collection Page 2 of 3 14. Eye Color 15. Occupation aren Ga ————— ] BROWN. BUSINESSWOMAN = oe aoe 2 ee i aye - | Bower 20. Travel Plan: Date of Trip (mm/ad/yyvy) _Length o! “np 4 MONTHS U.K., S. AFRICA, ISRAEL, U.A.E., AFGHANISTAN, IRAN PLETED YOUR APPLICATION BE SURE TO SIGN AND DATE PAGE ONE gor bean DEL! A laid Ate Eset 0S-82 02-2008 2/24/2020 https://cedi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=42994A0... EFTA00151153

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Scanned Document Collection Page 3 of 3 travisa Wien You Need it Fasi™ Since 1981 Travisa Passport & Visa Service Letter of Authorization heb kO7 Date; Muy 4, 4008 : nari: Wid) Gisldnl Molk 1 3 Last, Fr Micttie, | AUTHORIZE TRAVISA PASSPORT & VISA SERVICE TO SUBMIT MY PASSPORT APPLICATION TO A U.S. PASSPORT AGENCY, AND TO ACCEPT DELIVERY OF THE PASSPORT ON MY BEHALF. Under the provisions of the Privacy Act of 1974 (Public Law 93-579,) no information may be released from U.S. Government files without prior written consent of the individual in question, Consequently an employee of the U.S. T= augport Agency cannot discuss the details of your passport application — with Travisa Passport & Visa Service without your permission. Please choose one of the ‘i | authorize the U.S. Passport Agency to diecuss any problems which may arise with my 7 Passport appication with Travisa Passport & Visa Service. Oo | want the U.S. Passport Agency to contact me directly should a problem arise with my passport application which concerns matters other than the date on which the passport will be ready for pick up. c A, —_—> (Orighhal Signature) https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=42994A0... 2/24/2020 EFTA00151154