EFTA00731357.pdf

Federal Bureau of Investigation - Privacy Waiver and Certification of Identity Page I of 1 Complete. sign. and mall fonoinei sanctions needed) U.S. Department of Justice Federal Bureau ofInvestigation Privacy Waiver and Certification of Identity rub Went Jeffrey E. Epstein Moises used: Current Address Date o/ Birth: Place cd Sint Social Security Number (optional): (opdent N or aggresses. employments. etc.. With may emelt the FBI in locatic the mounted intonation) I hereby waive my right to privacy. and t authonze the FM lo release any and all Information Sating ame to: (Name, address 6 phone or attorney or other designee) -- -Merr-tin —C7—Virerlirtrerriz 20 Park Piaz. , 1QICICI I Boston user peaky eS pain away swam madam he parson Guam neve and understand met j MA 02116 - 617 227 3700 any laisfficalion of tie Malementbperishable under the PrOvalems el Title 18. united States Code (U.S.C.). Sedan 100i by a MO al not more than 510.000 or by Inprisonmenl ol not mare Man Me yea, Of beak and mat roeveda or obtaining any recordist under raise pretenses is punishable raider the pronslons sande 5. U.SC . Section 552o (0O) as e misdemeanor sad by a line al no! more than 55.000 Mon./air Dale- http://foia.tbi.govhvaiver.htm 12/29/2009 EFTA00731357