FDLE Florida Department of
FDLE Florida Department of
Law Enforcement
Richard L. Swearingen
Commissioner
STATE OF FLORIDA
COUNTY OF LEON Criminal Investigations and Forensic Science Services Ron DeSardis, Governor
Enforcement and Investigative Support Ashley Moody. Attorney General
Post Office Box 1489 Jimmy Patron's, Chief Financial Officer
Tallahassee. FL 32303-1489 Nikki Fried. Commissioner of Agricultun)
1-888-357-7332
wwwfdle.staterius
CERTIFICATION OF DOCUMENTS
REGARDING JEFFREY E. EPSTEIN
, at the
partment of Law Enforcement FOLE), Tallahassee, Florida. As a records custodian. I
am responsible for maintaining records for Enforcement & Investigative Support, including,
among other duties, receiving and recording information provided by persons Of agencies to this
Department, either directly or indirectly, pursuant to the statutory duties imposed on such
persons or agencies under Florida law to which there was a duty to report. I am familiar with the
filing system for this information.
After being duly sworn, I hereby certify that the attached document(s), consisting of 6 page(s)
are true and accurate copies of records received and kept in the regular course of official
business by this Department of electronic or hard copy FDLE Sexual Predator/Offender
Registration forms electronically or manually submitted by persons or agencies with knowledge
of the events and were made at or near the time of the events to FDLE on or about January 5,
2017 and maintained within the Florida Department of Law Enforcement's sexual offender
database and/or physical hard copy file regarding JEFFREY E. EPSTEIN, a white male with the
date of birth of January 20, 1953.
Records Custodian)
SWORN TO AND SUBSCRIBED before me this 14th day of January, 2019.
11:46tary Public or other person authorized
to administer an oath (print, type or stamp
commissioned name of notary public) i% y.. NCN.I L WARD
t*1 Cortarisairt 0 GC 23860t
;1.5 Era
a fir ank4 Thu leer Faia linnets 81416-7019
Personally known _produced identification
Type of identification produced
Service • Integrity • Respect • Quality
EFTA00098593
Registration No: 916154 Person Number: 73274
FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM
Agency Name: Palm Beach County SO
"— Note: Your next ReRegistration month is July of 2017
Registration For: January 2017 - SEXUAL OFFENDER
Reason For Registration
O initial Registration El Scheduled Conegistration O lnlometIon Upden D Eorty/Lene noRegoestion
Registrant Information
Name JEFFREY E EPSTEIN 'SSW DOES Race: WNW
(Frst Wade Last, Suns)
Tisciesure of your Soda( Secunty Num ter (SSW) a mandatory pursuant to Floods law. SIC606$ 77521,943.0435, 944.807, Mat F.S.. and Weal Isw.42 USC 18901. et
seq. Use of your SSN is be the purposes of ele att.:awn. FDLE me/ share the ttnxmaten wet the other seences for ilea purpose'. Sex: Male
FL DLO( ID Card 0:
Place of Binh. Immigration Status: Not Appicatis
Currently on Probation/Parole: O No O yes
Probation Type: O State
OFederal
County Height 6'00' Weight: 180 lbS Halt
State
Cry Officer Name: Grey
Phone (
Officer Name: Phone:( )
Officer Name'
Canty Pl,nne ( ) Eyes: roue
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 stale/country
O Temporarily leaving Florida to visit another state/country
OMoving from another state to permanently establish a residence In Heckle
OVeiling from another state and establIsrang a temporary address in Florida
O Other (please describe) Oars of Departure:
Date of Arnval
Current Permanent Address Future Permanent Address
6100 Red Hook Quarters Ste B3
(Address Um 1)
Little St Janes !stands (Address Ure t)
(Address Line 2)
St Thomas VI 00802 (Address Line 2)
(Cry) (Stele) (Zip)
Counts St Thomas End Dale: (Cali
Counts (suite) (Za)
Still Date
O I do NOT have a permanent address at this thee.
Page 1 of 6 2017-01-05 3'12 16 IN
EFTA00098594
Registration No: 916154 Person Number: 73274
Temporary Addresses El l do NOT nava • temPore•Y address
Please note: TM registrant has reported additional temporery eddressis• not displayed here
1. 358 El Bello Way Palm Beach FL 33480-4730 (Street Address) (City) (State) (Do)
County Paint Beach Dates you will be at this address: From: 071262012 To:
Transient Addresses Q I do NOT have a transient address
1.
Parer address or button)
Chu*: (City)
Dales you vial be at this address: From: (State) (Ad
To:
Employment 1 am currently unemployed.
1. Employer: Financial Trust Company
Address: 6100 Red Hook Quarter Ste B3
(Sheet Mans)
County Saint Thomas 0004>a000: Owner
St Thomas
(Coe
Contact Person.Sian Dale: 07/26/2012
VI 00)02
Plate/ (Zip)
Mailing Address
Oism* as Permanent name as Temporary Pleas* note: The registrant has reported additional Phone Numbers phone* not dispayed here.
ado NOT have or use any horns or mobile phone numbers
9 E 71st St
1.
2.
3.
4.
5 Phone Number: Phone Type:
Home (address Line 1)
Roblin (Address Line 2)
New York NY 10021 Fax
(00/)
County. New York (State) (Zip)
End Gate: WO*
Fax
Campus Activity CIlard NOT a Stuart, employes, or volunteer et e university or Institution of highs' learning.
1. 0 Studera O Employee O Volunteer
University/School Name:
Address:
County (Seem address) Stan Date End Date.
Err(loye-Campus:
(Cray)
Contact: (State) (Zip)
Professional Licenses El I do NOT has any professional licenses
1
(1.4„mbe" i.stuot by)
Page 7 of 6 2017-01-05 3:12 irtp24
EFTA00098595
Registration No: 916154 Person Number: 73274
Passport OI do NOT Mtn • Passport
1. C1 34c1578
(Numboo 10/11/2016
Moue OEle) 10/10/2024
(Furaireerin lame)
Email/Internet Identifiers O I do NOT use any ma addresses or Internet kientifieri.
Pima note: The registrant has reported eddldonel anon* account, not displayed Mn.
ctumboaclontollayahoo corn, J oeoroiectOyehoo con
SCRXS/Ma theTaftoos ID I do NOT have tiny Score, Marks or Tenons.
1.
(TYPO) (Locator') (Description)
2.
hype) (Location) (3SsCdpeon)
Vehicles Olds NOT awn or use a rebid,. RV, trailer or mobile home.
Pins* note: The Indetriare Ma reported additional vehicle. not displayed here.
1. 2013 Ford
(Veer) (Make)
522rzz NM This vehicle Is El NOT used as a reerlence O Used se • ressience 0 Owned by registrant
Nome Tag it) (Dab) EXPEDITION
(Model) (ereorreolor Scheme) (Vehicle Type) Black Truck
2. 2012 Coeliac
(Vat) (Make) OTHER
(tecess) Black
(rokusColor Scheme) IRKS
(Wilde Typo)
b3455 NY This vehicle Is: Q NOT used as a residence O Used es a residents. 0 Owned by napidnani
(Lama Tee in (Simla)
Vessels CI I do NOT oven • vessel or houseboat.
Please note: The registrant has reported addItIonal vessels not displayed here.
1. 2011 Other
;Year) (Venal T>pot
ye;
(Ftecisiration pl This vessel is White
(Cobdcotri Sonoma) (Name ci Vessel
ElNOT used as • residence ❑ Used as • residence
Adjudication Information
1.
2. Dale Adjudicated Crime Location of AdjudicatioNConviction Victm Information
• (Slate)O lArbm OM" (County)
(County) ISIS) OMoor O Gender.
Gender:
Were you or are you subject le registration a ozmmunity notification th another state? O Yes No If Yes. In what state?
Page 3 ()le WIZ-oyes 3212.19114
EFTA00098596
Registration No: 916154 Person Number: 73274
NOTICE OF SEXUAL PREDATOR AND SEXUAL OFFENDER OBLIGATIONS
Asa 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:
Internet identifier means all electronic mail, chat, instant messenger, social networking. application software, or similar names used
for Internet communication, but does not include a date of birth, social security number, or personal identification number (PIN). Voluntary
disclosure by a sexual predator of his or her date of birth. social security number, or PIN as an Internet identifier waives the disclosure
exemption in this paragraph for such personal information.
"Permanent residence" means a place where I abide. lodge, or reside for 5 or more consecutive days.
"Professional license" means the document of authorization or certification issued to me by an agency of this state for a regulatory purpose,
or by any similar agency in another jurisdiction for a regulatory purpose, for me to engage In an occupation or cany out a trade or business.
"Temporary residence" means a place where I abide. lodge, or reside, 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 my permanent
address or, if my permanent residence is not in this state, a place where I am employed, practice a vocation, or am enrolled as a student
for any period of time in this state.
"Transient residence" means a county whore I remain, or am located for a period of 5 or more days in the aggregate during a calendar
year and which is not my permanent or temporary address. The term includes, but is not limited to, a place where I sleep or seek shelter
and a location that has no specific street address.
"Vehicles owned" means any motor vehicle as defined ins. 320.01. which is registered, co-registered, leased, titled, or rented by me; a
rented vehicle that I am authorized to drive; or a vehicle for which I am insured as a driver. The term also includes any motor vehicle as
defined In s. 320.01, which Is registered, co-registered, leased, titled, or rented by a person or persons residing at my permanent residence
for 5 or more consecutive days.
1. Within 48 hours of establishing or maintaining a residence in this state, or 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), I MUST report
in anon to the local sheriffs office to register my temporary, transient, or permanent address and other information specified In statute.
If I am convicted of an offense that requires registration and am not under custody and/or supervision of DOC I must report In mom to
the sheriffs office In the county of conviction within 48 hours of the conviction.(F.S. 943.O435(2Xe); 77521(8Xe)).
FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY.
2. At registration, I MUST provide the following information to the department: name: date of birth: social security number; race; sex; height;
weight; tattoos or other identifying marks; hair and eye color; photograph; all home telephone numbers end cellular telephone numbers; all
electronic mail addresses and all Internet identifiers required to be provided pursuant to paragraphs. 943.0435(4)(e) F.S. or s. 775.21(8)
(9)5 F.S.; address of all permanent and legs residences; address of any current temporary residence; any transient residence within
the state; address, location, description and dates of any current or known future temporary residence within the state or out of state;
occupation and place of employment; make, model, color, vehicle Identification number (VIN), and license tag number of all vehicles
owned; date and place of each conviction; fingerprints; palm prints; and a brief description of the crime or crimes committed. I must also
produce my passport (if I have one). If I am an alien, I must produce or provide information about documents establishing my immigration
status. I must also provide information about all professional licenses I have. (F.S. 943.0435(2Kb); 775.21(8)(8)1.).
FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY.
3. Within 48 hours after the initial registration of information as required in s2 above. I MUST report binge to the driver 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 license or identification card displaying one of the following designations: "SEXUAL PREDATOR"
or "943.0435, F.S." unless a driver license or identification card with such designation was previously secured or updated. I must 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)(f)).
FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A THIRD DEGREE FELONY.
4. Before using any electronic mail address or Internet Identifier I MUST report It using the online system maintained by the Florida
Department of Law Enforcement or In Denson at the sheriffs office. OR, if I am on supervision with the Florida DOC or DJJ. this information
MUST be reported to my probation officer before using such electronic mail addresses or Internet identifiers. (F.S. 943.0435(4X4)1.;
775.21(6Xg)5.a.1.
FAILURE TO REPORT THIS INFORMATION PRIOR TO USE IS A THIRD DEGREE FELONY.
Page 4 of 6 70174146312'19 PI!
EFTA00098597
Registration No: 916154 Person Number: 73274
5. Each time my driver 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 license office
to update my driver license or identification card and ensure that the driver license or identification card displays the designations as
identified in e3 above. If I am unable to secure or update a driver license or identification card with DHSMV, I must also report any change
of my residence or name within 48 hours after the change to the sheriffs office in the county where I reside or am located and provide
confirmation that I reported the information to DHSMV. These reporting requireMerits do NOT negate the reettirement for me to obtain a
Florida driver llcense,or ifeintifiCatien Calla required by this section.(F.S. 943.0435(4)(a), 775.21(6)(9)1.).
FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A THIRD DEGREE FELONY.
6. If I am enrolled or employed, whether for compensation or as a volunteer at an institution of higher education in Florida, I MUST provide
the name, address and county of each institution including each campus attended, and my enrollment, volunteer, or employment status.
Each change In enrolment. volunteer, or employment status, I.e. commencement or termination, MUST be reported using the online
system maintained by the Florida Department of Law Enforcement or in person at the sheriffs office within 48 hours after any change in
status. OR, if I am on supervision with the Florida DOC or DJJ, this Information MUST be reported to my probation officer within 48 hours
after any change in status. (F.S. 943.0435(2)(b)2.: 943.0435(14)(C)24 775.21(6Xa)1.b.; 775.21(8X1)24.
FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY.
7. I MUST report all changes to home telephone numbers and cellular telephone numbers, Including added and deleted numbers
within 48 hours of any change in the Information using the online system maintained by the Florida Department of Law Enforcement
or in person at the sheriffs office. OR, if I am on supervision with the Florida DOC or DJJ, this information MUST be reported to my
probation officer within 48 hours of any change. {F.S. 943.0435(4)(e)2.; 775.21(8X9)5.b.}.
FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY.
8. I MUST report all changes to employment Information within 48 hours of any change In the Information using the online system
maintained by the Florida Department of Law Enforcement or in person at the sheriffs office. OR, iI I am on supervision with the Florida
DOC or DJJ, this information MUST be reported to my probation officer within 48 hours of any change. (F.S. 943.0435(4Xe)2.; 775.21(6)
(915.b.}.
FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY.
9. I MUST report any changes In vehicles owned within 48 hours Maroon at the sheriffs office. (F.S. 943.0435(2)(b)3.; 775.21(6)(8)1.cl
FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY.
10. If I vacate a permanent, temporary. or transient residence, and do not have another permanent, temporary, or transient residence. I
MUST report laPite.g0 to the sheriffs office in the county where I am located within 48 hours. (F.S. 943.0435(4)(b)1.; 776.21(602.a.).
FAILURE TO REPORT THIS INFORMATION WITHIN 48 HOURS IS A THIRD DEGREE FELONY.
11. It I report that I have vacated a permanent. temporary, or transient residence and then remain at that residence, I MUST report In oersog
to the Sheriffs 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)(9)3.).
FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY.
12. I understand that my address may be verified by county, state, or local taw enforcement agencies. IRS. 943.0435(8); 775.21(8)).
13. If I Intend on establishing a permanent, temporary, or transient residence in another state, jurisdiction, or country 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, or at least 21 days before my planned departure date if
the intended residence of 5 days or more is outside of the United States. I MUST provide the address, municipality, county, state, and
country of Intended residence. For international travel I MUST also provide my travel information, including, but not limited to, expected
departure and return dates. flight number. airport of departure, cruise port of departure, or any other means of Intended travel. If I do not
know of my travel outside of the United States 21 days before my departure date, then I MUST report In OtrIKKI to the sheriffs office in
the county of my current residence as soon as possible before my departure.(F.S. 943.0435(7); 775.21(6X0) -
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
14. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida, or
another country, and later decide to remain in this state, I MUST rapert trimmer' to the sheriffs office to which I reported my Intention
of leaving the state within 48 hours after the intended departure date. (F.S. 943.0435(8); 775.21(6)(0).
FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY.
15. I MUST report trigeneg either two tire's MUNN (during the month of my birth and during the 6th month following my birth month) or
toll[ times (once during the month of my birth and every 3rd month thereafter), depending upon my offense/dealgnation,
to the sheriffs office in the county in which I reside or am otherwise located to reregister, unless otherwise notified by FOLE.{F.S.
943.0435(14XaMb); 775.21(8X')).
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
Pope 5 of. 2917-01-0s 3.17 19 PM
EFTA00098598
Registration No: 916154 Person Number: 73274
All sexual predators, sexual offenders convicted for offenses specified in F.S. 943.0435(14)(6). and juvenile sexual offenders
required to register per F.S. 943.0435(1)(h)1.d. are required to reregister lour times per year. All other sexual offenders are
required to reregister two times per year.
Eli AM REQUIRED TO REREGISTER
TWO TIMES PER YEAR; I MUST
REREGISTER AS NOTED BELOW.
{Pursuant to Sections 943.0435(14)(a),
944.607(13)(a), Florida Statutes}
Month
of Birth
Jan
Feb I must
reregister In:
Jan & July
Feb & Aug
Mar & Sept Mar
April
May
June April & Oct
May & Nov
June & Dec Month
of Birth I must
reregister in:
July Jan & July
Feb & Aug
mars Sept Aug
Sept
Oct April& Oct
Nov May & Nov
Dec June & Dec I AM REQUIRED TO REREGISTER
FOUR TIMES PER YEAR; I MUST
REREGISTER AS NOTED BELOW.
{Pursuant to Sections 775.21(8)(a), 943.0435(14)(b},
944.607(13)(b), 985.4815 13O), Florida Statutes)
Month
of Birth
Jan
Feb
Mar I must reregister In:
Jan, April. July & Oct
Feb, May. Aug. & Nov
Mar, June, Sept & Dec Month
of Birth I must reregister In:
July
Aug
Sept Jan, April. July & Oct
Feb. May. Aug, & Nov
Mar, June, Sept & Dec
April April, July, Oct & Jan
May, Aug. Nov & Feb Oct April, July, Oct 6 Jan
May, Aug, Nov & Feb
June, Sept. Dec & Mar May
June June. Sept. Dec & Mar Nov
Dec
16. In addition to the registration months listed above, I MUST report iniLiereen to the sheriffs office n the county in which I am located within
48 hours of establishing a transient residence and thereafter must report in Person every 30 days to the sheriffs office in the county
in which I am located while I maintain a transient residence. I MUST provide the addresses and locations where I maintain a transient
residence. (F.S. 943.0435(4Kb)2.; 775.2103X9)2.b.).
FAILURE TO REPORT IS A THIRD DEGREE FELONY.
17. If I live in another state, but work or attend school in Florida. I MUST register my work or school address as a temporary address within
48 hours by reporting ID person to the local sheriffs office. (F.S. 943.0435(2)(a); 943.0435(2Kb)2.: 943.0435(14KC)2.; 775.21(6)(01.b.:
775.21(60)1.; 775.21(8X02.).
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
18. I MUST respond to any address verification correspondence from FOIE within three weeks of the date of the correspondence. {F.S.
943.0435(14Kc)4.; 775.21(10)M.
FAILURE TO RESPOND AS REQUIRED IS A THIRD DEGREE FELONY.
19. If I am employed in, carry on a vocation in, am a student in, or become a resident of another state or jurisdiction, I am on notice that I
may have a requirement to register under the laws of that state.
20. If I fail to register after crossing state lines I may be in violation of federal law as well as state statutes.
21.1 MUST maintain registration for the duration of my life. (F.S. 943.0435(11); 775.21(6)(I)Y
22. KNOWINGLY PROVIDING FALSE REGISTRATION INFORMATION BY ACT OR OMISSION IS A THIRD
DEGREE FELONY.{F.S. 943.0435(14)(c)4.; 775.21(10Xa)}.
REGISTRATION INFORMATION IS PUBUSHED ON THE FDLE PUBUC SEXUAL PREDATOR AND OFFENDER WEBSITE.
PLEASE READ CAREFULLY BEFORE 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 fisted 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 TO REREGISTER EACH YEAR AT THE SHERIFF'S OFFICE IN THE MONTHS OF
January AND July.
Registrant:
S gneiure Required
Printed Name: JEFFREY E EPSTEIN Witnessed by Reporting Officer:
Date: 01105/2017 Printed Name Ftmnit
Signature Roptated
Date: 01/05/2017
• OFFICIAL DOCUMENT DO NOT DESTROY*
NOTE: Your next ReRegistration month Is July of 2017.
Ptgo 6 of 6 20_77-01-057-01-05 3]219
EFTA00098599
FDLE Florida Department of
Law Enforcement
Richard L. Swearingen
Commissioner
STATE OF FLORIDA
COUNTY OF LEON Criminal Investigations and Forensic Science Services Ron DeSantis. Governor
Enforcement and Investigative Support Ashley Moody, Attorney General
Post Office Box 1489 Jimmy Patronis, chief Financial Officer
Tallahassee. FL 32303-1489 Nikki Fried. Commissioner of Agriculture
1-888-357-7332
www.fdle.state.fl.us
CERTIFICATION OF DOCUMENTS
REGARDING JEFFREY E. EPSTEIN
, at the
orida Department of Law Enforcement (POLE), Tallahassee. Florida. As a records custodian. I
am responsible for maintaining records for Enforcement & Investigative Support, including,
among other duties, receiving and recording information provided by persons or agencies to this
Department, either directly or indirectly, pursuant to the statutory duties imposed on such
persons or agencies under Florida law to which there was a duty to report. I am familiar with the
filing system for this information.
After being duly sworn, I hereby certify that the attached document(s), consisting of 6 page(s)
are true and accurate copies of records received and kept in the regular course of official
business by this Department of electronic or hard copy FDLE Sexual Predator/Offender
Registration forms electronically or manually submitted by persons or agencies with knowledge
of the events and were made at or near the time of the events to FDLE on or about July 11,
2016 and maintained within the Florida Department of Law Enforcement's sexual offender
database and/or physical hard copy file regarding JEFFREY E. EPSTEIN, a white male with the
date of birth of Janua 20 1953.
eco •s ustodian)
SWORN TO AND SUBSCRIBED before me this 14th day of January, 2019.
2 -;)
Notary Public or other person authorized
to administer an oath (print, type or stamp
commissioned name of notary public) 01.4,t\ MOO L. WARD ci Commission a GG 238601 gi Expires October 12, 2022 -": ce, .- 4' Bordid TM Tan Fin Inmate 10)45-7011
Personally known or produced identification
Type of identification produced
Service • Integrity • Respect • Quality
EFTA00098600
Registration No: 862790 Person Number: 73274
FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM
Agency Name: Palm Beach County SO
Note: Your next ReRegistration month is January of 2017
Registration For: July 2016 -SEXUAL OFFENDER
Reason For Registration
O miss areastrelion aScheduled ReFtegistraton Oifilormenon Update O tenets. aeRegisrmion
Registrant Information
Name: JEFFREY E EPSTEIN
(Few mos Lest Suffix)
'Disclosure of your Social Securely Number (SSN) is mandatory pursuant to Folds Irw. Sictons 775.21. 943.043.5. 944.607. 986.451. F.S end federal law. 42 USC 15S0 I. m seq. Use of your SSN is for the imposes of Metrication. F0LE may share the information with the of es agencies for the same purpose.
Ft. DL or ID Card A E123425530200 Height 5. 00' Weight Ise les Hair Grey Eyes Blue
Place of NT: Immigration Status: Not Applicable 'SSN: DOS: Race White Sex: Male
Currently on ProbatioNParole: El No El Yes
Probation Type: O State
O Federal
OCounty Sesto
City Officer Name:
Officer Name: Phone: ( )
Phone ( )
Officer Name'
County Phone ( )
Out of State Travel Information (Complete if permanent, temporary, or transient address Is out of state)
Permanently leaving Florida to establish a residence in another state/country
0 Temporarily leaving Florkle to visit another stale/county
0 Moving from another slate to permanentfy estabash a residence in Florida
0 Visaing from another state and establishing a temporary address in Florida
0 Other (please describe): mate of Departure:
Date of Arms':
Current Permanent Address Future Permanent Address
6100 Red Hook Quarters Ste 83
(Address Line 1)
Lithe St James islands (address Line 1)
(Address Line 2)
St Thomas VI 00802 (Address Una 2)
(Cory) (State) Rim
County SI Thomas End Dale: May)
County i (State) (TV)
Start Date
0 I do NOT have a permanent address at Ills time.
Page 1 dot 20160l-1 I 10322 PM
EFTA00098601
Registration No: 862790 Person Number: 73274
Temporary Addresses ado NOT have • temporary address
Pima note: The recite trent hes reported additional temporary 'Adrenal, not displayed here.
1. 360 El Salo Way
(stem /Wren)
County. Pakn Beach Palm Brach
(City)
Dates you will be at this address FL 33480-4730
(Stele) (Zip)
From: 07/26/2012 To:
Transient Addresses a I do NOT Nays a ban Sat addren
1.
(Street Address or location)
County (City)
Dates you will be al this address: From: (Stem) Zip)
To
Employment Oi 11111 currently unemployed.
1. Employer: Financial Trust Company
Address: 6100 Red Hook Quarter Ste 83
(Weil Address)
Cow* Saint Thomas 0041-cabon: Owner
St Therms
(eiry)
Contact Person.Start Date: 07/26/2012
VI 00802
(State) (Zip)
Mailing Address
O see se peewee ❑tlentese Teeperaly ROOS* note: The registrant has reported additional Phone Numbers phones not displayed here.
Oldie NOT hen or use any horn* or mobile phone numbers
9E 71st St Phone Number: Phone Type:
(Address Lino I) 1. m1)655-7626 Home
2. (212)533.3739 Mobile (Address Line 2)
Now York NY 1(021 3. (561)656.3572 Fax
(Cry) (SOW a) S. (304) 775-8135 Work
County New York End Eisie: 5. (505)938-2924 Fax
Campus Activity I ern NOT a student, employee, or volunteer at • university or Institution of higher learning.
1. E O Employee O Votiri!ntr
Unlyervty/Sthool Name.
Addro5$
County Start Date. End Date.
Campus:
(Steel Address)
Employer Contact: (Sum) Rio
Professional Licenses OI do NOT nave any professlortel licensee.
1.
Inumber) n) 'yl
Page 2 of 6 2j21+(17-11 1 03 32 per
EFTA00098602
Registration No: 862790 Person Number: 73274
Passport ElI do NOT hew • Preport InformalIon.
(issue Date) Mahan Date)
Email/Internet Identifiers . I do NOT use any serail addressee or ~mat lantifiea.
Please not*: The registrant has reported additional on:Ine accounts not Ole plepad han.
1.
2. Email Addresses
1.
2. Narre. Internist Identifiers
Provider
columbiadantell @ye hoocom
Merdonct@yahoo corn __
Scars/Markarrattoos El I do NOT aye any Scare Mara or Tattoo..
.
(Two) (LOoslIOn) ;Vase, ?Soo/
2.
Moe) (Location) Peltenlitin)
Vehicles El I do NOT own or use • wade, RV. Wailer or MOW. home.
Plato not*: The fogatinent has reported additional vehicles not displayed hors.
1. 2013 Ford
(Year) (Make)
522rzz NM
(Liens Tag I) (Stole) ITNO. VONCIO EXPEDITION
(Mode) Bad< Trick
(Color/Coax Scheme) (Volta Type)
NOT use.] as a endows El Used asa ~woe 0 owned by relPalten
2. 2012 Cadillac
(Tar) (Mae)
114455 NY This vehicle is 9 NOT used as a mallets D used as a residence D Owned by regnant
(Lama Tag 8) ($1848) OTH FR
(Model) Black
(Cedar/Gar Shame) (Valid* Tr») Truck
Vessels D I do NOT own • veal or houaboa.
Phan note: The raietraM has reported ~Morel vessels not displayed here.
1. 2011 Other
(TS) (Vaal Tao)
yea
(Registration le White
(Celor/Colo• Schwa) (Name of Vesale)
11* yens as: El NOT laic as • =dace D Used es • residence
Adjudication Information
1.
2. Dale Acfpuchcaled Come Location of Adjudir.alioniConectiOn Victim Inky-Mahon
(County) (State) ua OAOo
❑ Minor D Ad, (Carry) (Suite) Gender.
Gender
Were you or are you subject to registration or community notification In another stole? area No If Yes, in what slate? _
Page 3 016 201647.11 1:4332 PL
EFTA00098603
Registration No: 862790 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 I abide, lodge, or reside for 5 or more consecutive days.
"Temporary residence" means a place where I abide, lodge, or reside, 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 my permanent address or, if my permanent residence Is not in this state, a place where I am employed, practice
a vocation, or am enrolled as a student for any period of time In this state.
"Transient residence" means a county where I live, remain, a am located for a period of 5 or more days In the aggregate
during a calendar year and which is not my permanent or temporary address. The term includes, but is not limited to, a place
where I sleep or seek shelter and a location that has no specific street address.
"Internet Identifier means all electronic mail, chat, instant messenger, social networking, application software. or similar
names used for Internet communication. Use of my date of birth, social security number, or PIN as an Internet identifier waives
the disclosure exemption for such personal information.
"Vehicles owned" means any motor vehicle as defined in s. 320.01, which is registered, co-registered, leased, titled, or rented
by me: a rented vehicle that I am authorized to drive; or a vehicle for which I am insured as a driver. The term also Includes
any motor vehicle as defined in s. 320.01, which is registered, co-registered, leased, titled, or rented by a person or persons
residing at my permanent residence for 5 or more consecutive days.
1. Within 48 hours of establishing or maintaining a residence In this state, or 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), I MUST report In person to the local sheriffs office to register my temporary, transient, or permanent address
and other Information specified in statute. If I am convicted of an offense that requires registration and am not under custody
and/or supervision of DOC I must report In person to the sheriffs office in the county of conviction within 48 hours of the
conviction.(F.S. 943.0435(2)(a); 775.21(6X8)).
FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY.
2. At registration, I MUST provide the following information to the department: name; date of birth: social security number;
race; sex; height; weight tattoos or other Identifying marks; hair and eye color, photograph; all home telephone numbers
and cellular telephone numbers; al electronic mail addresses and all Internet Identifiers required to be provided pursuant to
paragraph s. 943.0435(4)(e) F.S. or s. 775.21(6)(g)5 F.S.; address of all permanent and legal residences; address of any
current temporary residence; any transient residence within the state; address, location, description and dates of any current
or known future temporary residence within the stale or out of state; occupation and place of employment; make, model,
color, vehicle Identification number (VIN), and license tag number of all vehicles owned; date and place of each conviction;
fingerprints; palm prints; and a brief description of the crime or crimes committed. I must also produce my passport (If I have
one). If I am an alien, I must produce or provide Information about documents establishing my immigration status. I must
also provide information about all professional licenses I have. (F.S. 943.0435(2)(b); 775.21(6)(a)11.
FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY.
3. Within 48 hours after the initial registration of Information as required in #2 above, I MUST report In person to the driver
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 license or identification card displaying one of the
following designations: "SEXUAL PREDATOR" or "943.0435, F.S." unless a driver license or Identification card with such
designation was previously secured or updated. I must 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).
FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A
THIRD DEGREE FELONY.
Pegs 4 a6 241147 -11 11/22PAI
EFTA00098604
Registration No: 862790 Person Number: 73274
4. Each time my driver 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 license office to update my driver license or identification card and ensure that the driver license or identification
card displays the designations as identified in #3 above. If I am unable to secure or update a driver license or identification
card with DHSMV, I must also report any change of my residence or name within 48 hours after the change to the sheriffs
office in the county where I reside or am located and provide confirmation that I reported the information to DHSMV. (F.S.
943.0435(4)(a); 775.21(6)(g)1}.
FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A
THIRD DEGREE FELONY.
5. If I am enrolled, employed, volunteering 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 attended, and my enrollment, volunteer,
or employment status. Each change in enrollment, volunteer, or employment status, I.e. commencement or termination,
MUST be reported lnaregn at the sheriffs office within 48 hours after any change in status. OR, if I am on supervision
with the Florida DOC or DJJ, this information MUST be reported to my probation officer within 48 hours after any change
in status. (F.S. 943.0435(2)(b)2; 943.0435(14)(c)2; 775.21(6)(a)1 .b; 775.21(8)(a)2}.
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
6. Before using any electronic mail address or Internet identifier I MUST report it using the online system maintained by the
Florida Department of Law Enforcement or In person at the sheriffs office. {F.S. 943.0435(4)(e); 775.21(6XO).
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
7. I MUST report any changes in vehicles owned within 48 hours In person at the sheriffs office. {F.S. 943.0435(2)(b)3;
775.21(6)(a)1.c).
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
8. If I vacate a permanent, temporary, or transient residence, and do not have another permanent, temporary, or transient
residence, I MUST report In person to the sheriffs office in the county where I am located within 48 hours. (F.S. 943.0435(4)
(b)1; 775.21(6Xg)2.4
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
9. If I report that I have vacated a permanent, temporary, or transient residence and then remain at that residence, I MUST
report in_peregn to the Sheriffs 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(6X9)3).
FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY.
10. I understand that my address may be verified by county, state, or local law enforcement agencies. {F.S. 943.0435(6);
775.21(8)).
11. If I intend on establishing a permanent, temporary, or transient residence in another state, jurisdiction, or country other
than the State of Florida, I MUST report in_stuagn 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, or within 21
days before my planned departure date if the intended residence of 5 days or more is outside of the United States. (F.S.
943.0435(7); 775.21 (6Xi)}.
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
12. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of
Florida, or another country, and later decide to remain in this state, I MUST report Inman to the sheriffs office to which I
reported my intention of leaving the state within 48 hours after the intended departure date. {F.S. 943.0435(8); 775.21(6XJ)}.
FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY.
13. I MUST report in person either two times per year (during the month of my birth and during the 6th month following
my birth month) or four times Rer_yitar (once during the month of my birth and every 3rd month thereafter), ckp_e_niang
upon my offense/design/atom to the sheriffs office in the county in which I reside or am otherwise located to reregister,
unless otherwise notified by FDLE.
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
Page 6 016 a916-07-111.0312PLA
EFTA00098605
Registration No: 862790 Person Number: 73274
All sexual predators, sexual offenders convicted kr offenses specified in F.S. 943.0435(14)(b), end juvenile sexual offenders required to register per F.S. 943.0435(1)(01.d are required to reregister four times per year. All other sexual offenders are
required to reregister two times per year.
nl AM REQUIRED TO REREGISTER
TWO TIMES PER YEAR; I MUST
REREGISTER AS NOTED BELOW.
{Pursuant to Sections 943.0435(14)(a),
944.607(13)(a), Florida Statutes}
Month
of Birth
Jan
Feb
Mar
Apd
May
June I must
reregister in:
Jan & July
Feb & Aug
Mar & Sept
April & Oct
May & Nov
June & Dec Month
of Birth I must
reregister In:
July
Aug
Sept Jan & July
Feb & Aug
Mar & Sept
Aprd & Oct Oct
Nov May & Nov
Dec June & Dec I AM REQUIRED TO REREGISTER
Fous TIMES PER YEAR; 1 MUST
REREGISTER AS NOTED BELOW.
{Pursuant to Sections 775.21(8Xa), 943.0435(14)(b),
944.607(13){b), 985.4815(13)(a}, Florida Statutes}
Month
of Birth I must reregister In:
Jan
Feb
Mar
April
May
June Jan. April, July & Oct
Feb, May. Aug, & Nov
Mar. June, Sept & Dec
April, July, Oct & Jan
May, Aug, Nov & Feb
June, Sept, Dec & Mar Month
of Birth I must reregister In:
July
Aug Jan, April, July & Oct
Feb, May, Aug, & Nov
Mar. June, Sept & Dec Sept
Oct April, July, Oct & Jan
May, Aug, Nov & Feb Nov
Dec June. Sept, Dec & Mar
14. In addition to the registration months listed above, MUST report in person to the sheriffs office In the county in which am located within 48 hours of establishing a transient residence and thereafter must report In person every 30 days to the sheriffs office in the county in which I am located while I maintain a transient residence. I MUST provide the addresses and locations where I maintain a transient residence. {ES. 943.0435(4){b)2; 775.21(6)(9)2.4
FAILURE TO REPORT ISA THIRD DEGREE FELONY.
15. If I live in another state, 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 person to the local sheriffs office. F.S.943.O435(2Xa); 943.0435(2)(b)2: 943.O435(14)(c)2; 775.21(6Xa)1.b: 775.21(6)(e)1; 775.21(8)(a)2}.
FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY.
16. I MUST respond to any address verification correspondence from weeks of the date of the correspondence. (F.S. 943.0435(14)(c)4; 775.21(10)(a)).
FAILURE TO RESPOND AS REQUIRED IS A THIRD DEGREE FELONY.
17. If I am employed in, carry on a vocation in, am a student in, or become a resident of another state or jurisdiction, I am on notice that I may have a requirement to register under the laws of that state.
18. I MUST maintain registration for the duration of my life. (F.S. 943.0435(11); 775.21(6)(0).
19. KNOWINGLY PROVIDING FALSE REGISTRATION INFORMATION BY ACT OR OMISSION IS A THIRD
DEGREE FELONY. (F.S. 943.0435(14)(c)4; 775.21(10)(a)) FDLE within three
REGISTRATION INFORMATION IS PUBLISHED ON THE FDLE PUBUC SEXUAL PREDATOR AND OFFENDER WEBSITE.
PLEASE READ CAREFULLY BEFORE SIGNING
Asa 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 TO REREGISTER EACH YEAR AT THE SHERIFF'S OFFICE IN THE MONTHS OF January AND July.
Registrant:
signsiuto Required
Printed Name: JEFFREY E EPSTEIN Witnessed by Reporting Officer:
Date: 07/11/2016 Printed Name: _Fingervit
Sorature RN:lured
• OFFICIAL DOCUMENT DO NOT DESTROY'
NOTE: Your next ReRegistration month is January of 2017.
Pogo a of Date: 07/11/2016
29150711 1'03'32 K1
EFTA00098606
FDLE Florida Department of
Law Enforcement
Richard L. Swearingen
Commissioner
STATE OF FLORIDA
COUNTY OF LEON Criminal Investigations and Forensic Science Services Ron DeSantis, Governor
Enforcement and Investigative Support Ashley Moody, Attorney General
Post Office Box 1489 Jimmy Patronis, Chief Financial Officer
Tallahassee, FL 32303.1489 Nikki Fried, Commissioner of Agriculture
1-888-357-7332
www.fdle.atateil.us
CERTIFICATION OF DOCUMENTS
REGARDING JEFFREY E. EPSTEIN
, at the
a Department of aw Enforcement (FDLE), Tallahassee, Florida. As a records custodian, I
am responsible for maintaining records for Enforcement & Investigative Support, including,
among other duties, receiving and recording information provided by persons or agencies to this
Department, either directly or indirectly, pursuant to the statutory duties imposed on such
persons or agencies under Florida law to which there was a duty to report. I am familiar with the
filing system for this information.
After being duly sworn, I hereby certify that the attached document(s), consisting of 6 page(s)
are true and accurate copies of records received and kept in the regular course of official
business by this Department of electronic or hard copy FDLE Sexual Predator/Offender
Registration forms electronically or manually submitted by persons or agencies with knowledge
of the events and were made at or near the time of the events to FDLE on or about June 29,
2016 and maintained within the Florida Department of Law Enforcement's sexual offender
database and/or physical hard copy file regarding JEFFREY E. EPSTEIN, a white male with the
date of birth of January 20, 1953.
(Records Custodian)
SWORN TO AND SUBSCRIBED before me this 14th day of January, 2019.
Nota blic or other person authorized
to minister an oath (print, type or stamp
commissioned name of notary public)
Personally known i..--'iicproduced identification
Type of identification produced VICKI L. WARD
COMIStion
G6,23860M 202:
2
Treffsi li betneco034164011
Service • Integrity • Respect • Quality
EFTA00098607
Registration No: 859077 Person Number: 73274
FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM
Agency Name: Palm Beach County SO
Note: Your next ReRegistration month is July of 2016
Registration For: June 2016-SEXUAL OFFENDER
Reason For Registration
OIntent Rocutrotton O Scheduled R•Regavaion aInformation Updsto D Eartykais ReRegistraton
Registrant Information
Name: JEFFREY E EPSTEIN
(Fat fasddle Last Sala)
'0scbeaeal YOuf S0C4ISKoillY Nolte (ESN) is man:N.10N pursuant to Fiends inv. wean M.21. 943.0435. 944.601. 96.5.01. F.S.. and federal law. 42 USC 16901. et
seq. Use Orem SSN s lot ate pompow of identilcaboe. FM may inom the inkammon wit the raw stenos lot the same papule. 'SSW DOB: Race. White Sex: Meier
R. Mot PO Card g: El234255302O0 Height 6' CO' wool: 180 lbs Hair:
Place of Bair Immigration Status Not Amicable
Cerra* on ProbadoriParole O No O Yes
Probation Type: O state
OFederal
OCounty Sate
City Officer Name: Grey Eyes: Blue
Phone:( )
Officer Name: Phone (
Officer Name:
Cowry Phone
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/m.40y
OTemporarily leaving Florida to visit another statelcountry
O Moving from another slate to permanently establish a residence In Florida
O Visiting from another state and establishing a temporary address in Florida
Ei Other (please describe) (Th'n of (\wan,
Crate of Arrniall
Current Permanent Address Future Permanent Address
6100 Red Hook Charters Ste B3
(Address Line 1)
1.11116 St James Islands (Address Line 1)
(Address Lira 2)
St Thomas VI 00802(Address Lino 2)
(Cory) (State) (Zip)
County: St Thomas End Date (City)
County: (Sate) (lc)
Sian Date _.
El I do NOT have a permanent address at this time. ----
Pse• Iola 201606292,18.43 PM
EFTA00098608
Registration No: 859077 Person Number: 73274
Temporary Addresses ❑ I do NOT have • temporary address
Rust note: The registrant has reported additional temporary oddment not displayed hare
1. 358 El Bello Way
(Sweat address)
County: Palm Beach Palm Bosch
(City) FL 33480 4730
(Stale) (Zip)
Dates you will be at this address: From: 07/26/2012 To:
Transient Addresses Q I do NOT have • transient address
1.
(Street Address or location)
County: (City)
Dates you will be at this address: From: (Stale) (Zil8
To:
EmpioYmant OI am currently unemployed.
1. Employer: Financial Trust Company
Address:
County. 8100 Red Hook Quartet Ste 83
(Sven Address)
Saint Thomas OttoPutkm Owner
St Thomas
(Csiy)
Contact Person. Slant Data: 07/28/2012
VI 00802
(State) WO
Mailing Address
OSame es Pleltillent purse as Temporary Pine* nOt.' Phone Numbers phones not displayed
El I do NOT have or use any home Ilis teintnant has reported additional
hen.
on mobile phone numbers
9 E 71st SI Phone Number:
1. (581)8W-7626 Phone Type:
Home (Address Line 1)
2. (212)533-3739 Mobile (Addreits line 7)
New York NY 10021 3. (581)8654872 Fax
(City)
County: New York Mugs) MO
End Date: 4. (304) 775-8135 Work
5. (505) 938.2924 Fax
Campus Activity I we NOT a student, employee. or volunteer et • unlveritly or InekutIon of higher lemming.
1 • O Student❑ Employ.. O vnityl'fInf
University/School Name:
Address
County Start Date. End Dale
(Stem Address)
Errgleyer.(Cry) Campus:
Contact (Slate) (Zip)
Professional Licenses E I do HOT have any professional licenses.
1.
(Mtn** (-11.")^) ...{.;cyl by)
Page 2 of 6 241888-232 .48 44.914
EFTA00098609
Registration No: 859077 Person Number: 73274
Passport MI do NOT have a Passport Information.
(Numbs') (Issue Date) ifispeabon Dub)
Email/Internet Identifiers . I do NOT us• any emelt addressee or Internet identifies.
Please nobs: The registrant ha reported additional online accounts not displayed here.
1.
2. Email Addresses
columbodental 16
📷 Images in this document (119 detected; 6 largest described)
AI-generated factual descriptions of embedded images (llava:13b). These are searchable across the corpus.
[Image 1] The image shows a document that appears to be a registration form or a similar type of official paperwork. It contains various sections with headings such as "Registration No," "Date," "Name," "Address," and "Signature." There are also numerical tables and fields for information to be filled out. The form is structured with lines and boxes for data entry. The document is printed on standard letter
[Image 2] The image shows a document that appears to be a medical report or a health-related form. It contains sections with headings such as "Patient Details," "History of Present Illness," "Chief Complaint," and "Physical Examination." There are fields for patient name, age, sex, address, and contact details. The form also includes sections for medical history, symptoms, and physical examination findings.
[Image 3] The image shows a document that appears to be a form or application. It contains various sections with headings such as "REGISTRATION NO." and "DATE OF BIRTH." There are fields for personal information, including name, address, and contact details. There are also sections for medical history and a declaration of health. The form includes checkboxes for certain conditions or treatments, and there a
[Image 4] The image shows a document that appears to be a registration form or a form of some sort. It contains text fields and checkboxes, which are typical for official forms. There are sections for personal information, such as name, address, and contact details. There are also sections for details about the applicant's employment or occupation, and a section for a signature at the bottom. The form is st
[Image 5] The image shows a document that appears to be a form or application. It contains various fields and checkboxes, some of which are filled out with text. There are also sections with signatures at the bottom. The document is structured with numbered paragraphs and sections, and it includes a table with columns and rows of information. The visible text includes phrases such as "Registration Number,"
[Image 6] The image shows a document that appears to be a form or a letter. It contains text and tables with numerical data. The visible text includes sections with headings such as "REGISTRATION FORM," "DETAILS OF THE APPLICANT," and "DETAILS OF THE EMPLOYEE." There are also sections with numerical data, possibly related to income or other financial information. The document is structured with numbered par