DOJ-OGR-00015172.pdf

Epstein VCP EPSTEIN VCP Claim ID: DOJ REDACTION Epstein Victims' Compensation Program For Victims-Survivors of Sexual Abuse by Jeffrey Epstein SM I am a licensed attorney or other representative authorized to represent and/or act on behalf of the Claimant identified herein, for purposes of this claim for compensation. Claimant Signature: DOJ REDACTION Printed Name: First DOJ REDACTION Middle DOJ REDACTION Last Date 6/26/2020 Notary Signature: State of Florida County of Broward The foregoing instrument was subscribed and sworn before me this 26th day of June ,20 20 by DOJ REDACTION My Commission expires 11/29/2021 Affix Seal Here: Signature of Notary Deborah Cifra Date June 26, 2020 2 of 2 Epstein Victims' Compensation Program Attn: Jordana H. Feldman, Administrator 1050 Connecticut Ave. NW #65488 Washington, D.C. 20035 13 DOJ-OGR-00015172