=) U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS eC aOOONGHIE (satan . gib ng Black ink O ESTIMATED BURDEN. 40 MIN Attention: Read WARNING on page 1 of instructions J Please select the document(s) for which you are applying: i: IX] U.S. Passport Book _L] US. Passport Card o Both | The U.S. passport card is pot valid for international ax travel. For more information see page 1 of mstructons. | \ 1 28 Page Book (Standard) [2] 52 Page Book (Non-Standard) [Bate The 22 pag anti fs for teone eto fracenras men since Gants Se pene on wae Pa and s recommended: Applicants who have previously roqured Bie adalon of visa pages 1. Name Last [ jo Do [_] pp ports Code EPSTEIN | End. # : Exp. First Middle as - JEFFREY EDWARD 2. Date of Birth (mm/dd/yyyy) 3. Sex 4. Place of Birth (City & State if in the U.S., or City & Country as it is presently known.) M i 01 20 # 1953 xX NEW YORK, NY 5. Social Security Number 6. Email Address (e.9., my_email@domain.com) 7. Primary Contact Phone Number 090 44 3348 JEEVACATION@GMAIL .COM 8. Mailing Address: Line 1: Street/RFD#, P.O. Box, or URB. 6100 RED HOOK QUARTER, B3 Address Line 2: Clearly label Apartment, Company, Suite, Unit, Building, Floor, in Care Of or Attention if applicable. (e.9., In Care Of - Jane Doe, Apt # 100) City State Zip Code Country, if outside the United States ST THOMAS vi 00802 9. List all other names you have used. (Examples: Birth Name, Maiden, Previous Marriage. Legal Name Change. Attach additional pages if needed) A 8. 40. Passport Book and/or Passport Card Information Your name as printed on your most recent U.S. passport book and/or passport card JEFFREY EPSTEIN Most recent passport book number Issue date (mmid/yyyy) 516923892 06/30/2014 Most recent passport card number Issue date (mmidd/yyyy) 44. Name Change Information Complete if name is different than last U.S. passport book or passport card Changed by Marriage Place of Name Change (City/State) Date (mmidd/yyyy) | a color h taken Changed by Court Order ASS Be BaP Pon Please submit a certified copy. (Photocopies are not accepted!) CONTINUE TO PAGE 2 YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED A\ BELOW “ ‘ 1 dectare under penaitty of perjury all of the following: 7) | am a citizen or non-citizen national of the United States and have not, since acquiring U.S. citizenship or nationality. performed any of the acts listed under “Acts or Conditions” on page four of the instructions of this application (unless explanatory statement ); 2) the made ‘on the application are true and correct: 3) | have not knowingly and willfully made faise statements or included false Submitted with this application is a genuine, current photograph of me; and 5) | have read and understood the waming on page one of the instructions to the FOR ISSUING OFFICE ONLY | pprekae [| ppTexsiR | | PPTCOGR || PPTCOSIR .] Mariage Certificate Date of Marriage/Place Issued {| Court Order Date Filed/Court: [] Other. Lae | , OI AT For Issuing Office Only = Bk Fee * DS 82 B 08 2013 1 * Page 1 of 2 DS-82 08.2013 EFTA00314126