EFTA00038704.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: 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. 3. Pan 6. Certification a. Have the FBI agent sign, date and include his telephone and fax number A A EFTA00038704 Supplement B, U Nonimmigrant Status Certification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form 1-918 OMB No. 1615-01 Expires 04/30/20 Remarks For USCIS Use Only ► START HERE - Type or print in black or blue ink. talit tr", 1. Alien Registration Number (A-Number) (if any) 11.- A- 2.a. Family Name (Last Namc) 2.b. Given Name (First Name) 2.c. Middle Name Other Names Used (Include maiden names, nicknames, and aliases, if applicable.) If you need extra space to provide additional names, use the space provided in Part 7. Additional Information. 3.a. Family Nam (Last Name) 3.b. Given Name (First Name) 3.c. Middle Nam 4. Date of Birth (mm/dcl/yyyy) 5. Gender O Male 0 Female 1. Name of Certifying Agency Federal Bureau of Investigations Name of Certifying Official 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 3. Title and Division/Office of Certifying Official Name of Head of Certifying Agency 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 5.a. Street Number and Name 5.b. q Apt. O Ste. O FIr. 5.c. City or Town 5.d. State 4.f. ZIP Code 5.f. Province 5.g. Postal Code 5.h. Country F 1 6 X1e•Lf,AL ". 6. Agency Type O Federal O State O Local 7. Case Slams ▪ On-going O Completed O Other 8. Cenifying Agency Category O Judge 0 Law Enforcement O Prosecutor O Other 9. Case Number 10. FBI Number or SID Number (if applicable) Form 1-918 Supplement B 04/24/2019 Page 1 5 EFTA00038705 Part 3. Crim last Acts If you need extra space to complete this section, use the space provided in Part 7. Additional Information. 1. The petitioner is a victim of criminal activity involving a violation of one of the following Federal, state, or local criminal offenses (or any similar activity). (Select all applicable boxes) q Abduction • Manslaughter q Abusive Sexual Contact • Murder q Attempt to Commit Any of the Named Crimes q Being Held Hostage q Blackmail q Conspiracy to Commit Any of the Named Crimes Domestic Violence Extortion False Imprisonment Felonious Assault Female Genital Mutilation q Fraud in Foreign Labor Contracting q Incest q Involuntary Servitude q Kidnapping 0 Obstruction of Justice Peonage Perjury Prostitution Rape Sexual Assault Sexual Exploitation Slave Trade q Solicitation to Commit Any of the Named Crimes q Stalking q Torture [] Trafficking q Unlawful Criminal Restraint q Witness Tampering Provide the dates on which the criminal activity occurred. 2.a. Date (mm/dd/yyyy) 2.b. Date (mm/dd/yyyy) 2.c. Date (mm/dd/yyyy) 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. 4.a. Did the criminal activity occur in the United States (including Indian country and military installations) or territories or possessions of the United States? O Yes O N 4.b. If you answered "Yes," where did the criminal activity occur? 5.a. Did the criminal activity violate a Federal extraterritori jurisdiction statute? ❑Yes ❑N 5.b. If you answered "Yes," provide the statutory citation providing the authority for extraterritorial jurisdiction. e A 6. Briefly describe the criminal activity being investigate and/or prosecuted and the involvement of the petitione named in Part 1. Attach copies of all relevant reports findings. 7. Provide a description of any known or documented inj to the victim. Attach copies of all relevant reports and fi ndings. A Form 1-918 Supplement B 04/24/2019 Page 2 5 EFTA00038706 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 EFTA00038707 A Part 5. Family Members Culpable In Criminal Activity 1. Arc any of the victim's family members culpable or believed to be culpable in the criminal activity of which the petitioner is a victim? Yes N No If you answered °Yes." list the family members and their criminal involvement. (If you need extra space to complete this section, use the space provided in Part 7. Additional Information.) 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 2.d. Relationship 2.e. Involvement 3.a. Family Name (Last Name) 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 Part 6. Certification I am the head of the agency listed in Part 2. or I am the pers in the agency who was specifically designated by the head of the agency to issue a U Nonimmigrant Status Certification o behalf of the agency. Based upon investigation of the facts, I certify, under penalty of perjury, that the individual identified Part 1. is or was a victim of one or more of the crimes listed Part 3. I certify that the above information is complete, true and correct to the best of my knowledge, and that I have ma and will make no promises regarding the above victim's abili to obtain a visa from U.S. Citizenship and Immigration Servi s (USCIS), based upon this certification. I further certify that i the victim unreasonably refuses to assist in the investigation prosecution of the qualifying criminal activity of which he o she is a victim, I will notify USCIS. I. Signature of Certifying Official (sign in ink) 4 2. Date of Signature (miniddiyyyy) 3. Daytime Telephone Number 4. Fax Number Form 1.918 Supplement a 04/24/2019 Page 4 g 5 A A EFTA00038708 Part 7. Additional Information 1 If you need extra space to complete any item within this supplement, use the space below or attach a separate sheet of paper; type or print the agency's name,