Send to: G3 Global Services Attn: Passport Department SAN FRANCISCO 388 Market Street, Suite 1520 ie | SECOND VALID PASSPORT 877.898.1203 | {x) Payment Via Credit Card: - ff (x) Concierge Service Requeste: : > aes 1s :. ‘ H at , ¥ Exp. Date:_11_/_19 Security Code: 35 7 one el leek @gSvicsaenn OR ae Exp.Date:_/_ Security Code: | || | |) Di Kh e Jerge 00 X | 175. _ = US Government Fee $170.00 X Billing Address: ‘575 Lexington Ave, 4th Floor G3 Service Fee | $275.00 X City: |NY State NY | Zip:| 10022 Passport Protection Plan | $40.00 X/ = BO Return Delivery Fee Signature: Subtotal $665 Add 5% for credit card convenience fee Total Fees frorn Applicable Fees Page {_) Payment Via Approved Billing Terms G3 Customer Number, Billing, P.0.., Project or Reference Code#: Total Payment Enclosed $702.20 __| Traveler Information Traveler 1 Name: Jeffrey Edward Epstein Date of Birth: 01/20/1953 Traveler 2 Name: Date of Birth: Passport Service Sortces: [35] Second Vaid Panspert Gack Oaly) Processing Speed: [) Mission Critical [—]Priorty {_] Expedited {_) Second Valid Passport (Book and Card) Travel Details Date of US Departure: ANTICIPATED 06/20/2016 I must have my passport no later than: 96/96/2016 Other visa or passport services requested: Notes: Contact Information Name: Darren K. Indyke Company: Darren K. Indyke, PLLC Conan daytime one Return Delivery Address Name: Darren K. Indyke Company: Darren K. Indyke, PLLC Street Address: S575 Lexington, 4th Floor Ci: New York ’ Zip Code: 49922 ——_ EFTA00314156