EFTA00155344.pdf

Attached is the Form I-9188, which needs to be completed and signed by the law enforcement agency. I have completed the parts I need to complete, but please make sure that the FBI completes the following: A 1. Part 2. Agency Information: a. (questions 1-3) Please complete the full name and title of the FBI agent signing the Form. b. (questions 4.2.-5.h.) include the name of the Head of the FBI and the address for the FBI Office c. (question 9.) include the court case number for defendant Ghislaine Maxwell 2. Part 3. Criminal Acts: a. (question 1.-3) I listed sexual exploitation and trafficking as the criminal activity for parts 2.a.-2.d. please list the dates the criminal activity occurred as alleged in the Indictment and the section of the USC code she is charged with b. (question 4.b.) list the city and state where the violations occurred c. (question 6.) Please describe the criminal activity being investigated according to the charges and allegations in the indictment d. (question 7) describe the injury to Ms. De Georgiou 3. Pan 6. Certification a. Have the FBI agent sign, date and include his telephone and fax number A EFTA00155344  Supplement B, U Nonimmigrant Status Certification USCIS Form 1-918 Department of Homeland Security OMB No. 1615-01 U.S. Citizenship and Immigration Services Expires 04/30/202 Remarks For 115C IS A Use Only ► START HERE - Type or print in black or blue ink. Part 1. Victim Information Name of Head of Certifying Agency 4.a. Family Name 1. Alien Registration Number (A-Number) (if any) (Last Name) ► A- 4.b. Given Name (First Name) 2.a. Family Na (Last Nam 4.c. Middle Name 2.b. Given Na (First Nam 2.c. Middle Name 5.a. Street Number Other Names Used (Include maiden names, nicknames, and and Name aliases, if applicable.) 5.b. ❑ Apt. ❑ Ste. ❑ FIr. A If you need extra space to provide additional names, use the space provided in Part 7. Additional Information. 5.c. City or Town 3.a. Family Na 5.d. State 4.f. ZIP Code (Last Na 3.b. Given Na 5.f. Province (First Nam 3.c. Middle Na 5.g. Postal Code 4. Date of Birth (nun/dd/yyyy) 5.h. Country 5. Gender O Male Ela Female Other Agency Information Part 2. Agency Information 6. Agency Type 1. Name of Certifying Agency O Federal O State ❑ Local Federal Bureau of Investigations 7. Case Status Name of Certifying Official O On-going ❑ Completed 2.a. Family Name ❑ Other (Last Name) 8. Certifying Agency Category 2.b. Given Name (First Name) ❑ Judge 0 Law Enforcement ❑ Prosecutor 2.c. Middle Name O Other 3. Title and Division/Office of Certifying Official 9. Case Number 10. FBI Number or SID Number (if applicable) Fenn 1-918 Supplement B 04/24/2019 Page 1 5 EFTA00155345  4.a. Did the criminal activity occur in the United States Part 3. Crim last Acts (including Indian country and military installations) or e If you need extra space to complete this section, use the space territories or possessions of the United States? A provided in Part 7. Additional Information. O Yes O N 1. The petitioner is a victim of criminal activity involving a 4.b. If you answered "Yes," where did the criminal activity violation of one of the following Federal, state, or local criminal offenses (or any similar activity). (Select all occur? applicable boxes) ❑ Abduction • Manslaughter ❑ Abusive Sexual Contact • Murder 5.a. Did the criminal activity violate a Federal extraterritori jurisdiction statute? ❑Yes ❑N ❑ Attempt to Commit Obstruction of Justice Any of the Named Peonage 5.b. If you answered "Yes," provide the statutory citation Crimes providing the authority for extraterritorial jurisdiction. Perjury ❑ Being Held Hostage Prostitution ❑ Blackmail Rape ❑ Conspiracy to Commit 6. Briefly describe the criminal activity being investigate Any of the Named Crimes 0 Sexual Assault and/or prosecuted and the involvement of the petitione Sexual Exploitation named in Part 1. Attach copies of all relevant reports Domestic Violence findings. Slave Trade Extortion ❑ Solicitation to False Imprisonment Commit Any of the Felonious Assault Named Crimes Female Genital ❑ Stalking Mutilation ❑ Torture ❑ Fraud in Foreign Labor [] Trafficking Contracting ❑ Unlawful Criminal ❑ Incest Restraint ❑ Involuntary Servitude ❑ Witness Tampering ❑ Kidnapping Provide the dates on which the criminal activity occurred. 2.a. Date (mm/dd/yyyy) 2.b. Date (mm/dd/yyyy) 7. Provide a description of any known or documented inj to the victim. Attach copies of all relevant reports and 2.c. Date (mm/dd/yyyy) findings. 2.d. Date (mm/dd/yyyy) 3. List the statutory citations for the criminal activity being investigated or prosecuted, or that was investigated or prosecuted. A Form 1-918 Supplement B 04/24/2019 Page 2 5 EFTA00155346  4. Other. Include any additional information you would I4e to provide. For the following questions, if the victim is undcr 16 years of age, incompetent or incapacitated, then a parent, guardian, or next friend may act on behalf of the victim. 1. Does the victim possess information concerning the criminal activity listed in Part 3.? La Yes 0 No 2. Has the victim been helpful, is the victim being helpful, or is the victim likely to be helpful in the investigation or prosecution of the criminal activity detailed above? El Yes 0 No 3. Since the initiation of cooperation, has the victim refused or failed to provide assistance reasonably requested in the investigation or prosecution of the criminal activity detailed above? 0 Yes 0 No If you answer "Yes" to Item Numbers 1. - 3., provide an explanation in the space below. If you need extra space to complete this section, use the space provided in Part 7. Additional Information. Form 1-918 Supplement B 04/24/2019 Page 3 5 EFTA00155347  A Part 5. Family Members Culpable In Criminal Part 6. Certification Activity I am the head of the agency listed in Part 2. or I am the pers 1. Arc any of the victim's family members culpable or in the agency who was specifically designated by the head of believed to be culpable in the criminal activity of which the agency to issue a U Nonimmigrant Status Certification o the petitioner is a victim? Yes N No behalf of the agency. Based upon investigation of the facts, I certify, under penalty of perjury, that the individual identified If you answered °Yes." list the family members and their Part 1. is or was a victim of one or more of the crimes listed criminal involvement. (If you need extra space to Part 3. I certify that the above information is complete, true complete this section, use the space provided in Part 7. and correct to the best of my knowledge, and that I have ma Additional Information.) and will make no promises regarding the above victim's abili to obtain a visa from U.S. Citizenship and Immigration Servi s 2.a. Family Name (Last Name) (USCIS), based upon this certification. I further certify that i the victim unreasonably refuses to assist in the investigation 2.b. Given Name (First Name) prosecution of the qualifying criminal activity of which he o A she is a victim, I will notify USCIS. 2.c. Middle Name I. Signature of Certifying Official (sign in ink) 2.d. Relationship 4 2. Date of Signature (miniddiyyyy) 2.e. Involvement 3. Daytime Telephone Number 3.a. Family Name (Last Name) 4. Fax Number 3.b. Given Name (First Namc) 3.c. Middle Name 3.d. Relationship 3.e. Involvement 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 4.d. Relationship 4.e. Involvement A Form 1.918 Supplement a 04/24/2019 Page 4 g 5 EFTA00155348 Part 7. Additional Information 1 5.a. Page Number 5.b. Part Number H 5.c. Item Num r If you need extra space to complete any item within this supplement, use the space below or attach a separate sheet of 5.d. paper; type or print the agency's name, petitioner's name, and the Alien Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. If you need more space than what is provided, you may also make copies of this page to complete and file with this supplement. I. Agency Name Federal Bureau of Investigations alehtroner's Name 2.a. Family Nam (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name A 3. A-Number (if any) Is. A- 6.a. Page Number 6.b. Part Number 6.c. Item Number 4.a. Page Number 4.b. Part Number 4 c. Item Number 1 L 6.d. I A A Form 1.918 Supplement B 04/24/2019 Page 515 EFTA00155349