DOJ Epstein Files, Data Set 1 (EFTA00003061)

00 R ed	S B Q ui -3 te H k rte ua rs oo	L C S L L J E , T I 0 08 02 S T ho , V t. m as	Fa el x: :

	E m e r	C t o n a c g e n c y	F t o r m
D at e C : 6’ 4’ 18			St t D 04 /2 0/ at 18 ar e:
E pl N m oy ee am e:	M ic ha G e J ,c ae n
rS J A dd re ss :			D of B irt h: at e
P ho nc	C el l:		M E- ai l:
/ Po si tio T itl n: En gi e	ne er	M ita l S ta tu D ivo ar s: rc e	Li ce ns e:
In fo er ge nc rm y	io at n :
A lle ie r H lth C rg s o ea on	ce rn s:
Bl d Ty oo pe :
C M nt ed ica tio ur re n:
D to r’s N oc am e:		P ho ne :
D to r’s N oc am e:		P ho ne :
	P le nc y, as e nt ct co a :
In of c as E e a n m er ge			Ph on
M ai ne	Re lat io hi ns	So p n	e
	Re lat io hi ns	p Br he ot r	Ph on e
	T hi In fo tio is s rm a n	fo of et d r th y o u r s y a n	fe t f e sa he y o ot rs