EFTA01263126 Part 6. Information About Your Residence and Employment A. Where have you lived during the last 5 years? Begin with where you live now and then list every place you lived for the last 5 years. If you need more space, use a separate sheet of paper. B. Where have you worked (or, if you were a student, what schools did you attend) during the last 5 years? Include military service. Begin with your current or latest employer and then list every place you have worked or studied for the last 5 years. If you need more space, use a separate sheet of paper.

Employer or School Name	Employer or School Address (Street, City and State)	Dates (Month/Year)		Your Occupation
Employer or School Name	Employer or School Address (Street, City and State)	From	To	Your Occupation
L.S.J., LLC	6100 Red Hk, St. Thom., USVI	0 8 2 7 0 1	Present	Manager
NES, LLC	457 Madison Ave., NY, NY	0 1 / 2 0 0 1	0 8 2 4 0 1	Manager
J. Epstein & Co.	457 Madison Ave., NY, NY	0 1 / 1 9 9 3	1 2 / 2 0 0 0	Manager
		--- / ---	--- / ---
		--- / ---	--- / ---

Form N-400 (Rev. 05/31/01)N Page 3 SDNY_GM_00000721 EFTA_00114805 EFTA01263127 B. How many trips of 24 hours or more have you taken outside of the United States during the past 5 years? C. List below all the trips of 24 hours or more that you have taken outside of the United States since becoming a Lawful Permanent Resident. Begin with your most recent trip. If you need more space, use a separate sheet of paper. See on attachment

Date You Left the United States(Month/Day/Year)	Date You Returned to the United States(Month/Day/Year)	Did Trip Last6 Months orMore?		Countries to Which You Traveled	Total DaysOut of theUnited States
11/18/2001	11/26/2001	□Yes	No	France, Italy, United Kingdom	8
09/21/2001	10/01/2001	□Yes	No	France, Italy, United Kingdom	10
07/19/2001	08/01/2001	□Yes	No	United Kingdom, France	12
06/22/2001	06/29/2001	□Yes	No	France	7
05/17/2001	05/20/2001	□Yes	No	Canada	3
03/05/2001	03/11/2001	□Yes	No	France, United Kingdom	6
12/04/2000	12/09/2000	□Yes	No	France, United Kingdom	5
10/25/2000	10/29/2000	□Yes	No	United Kingdom	4
08/31/2000	09/04/2000	□Yes	No	United Kingdom	4
07/05/2000	07/17/2000	□Yes	No	France, United Kingdom	12

## Part 8. Information About Your Marital History A. How many times have you been married (including annulled marriages)? If you have NEVER been married, go to Part 9. B. If you are now married, give the following information about your spouse: SDNY_GM_00000722 Form N-400{Rev: 05/31/01}N Page 4 EFTA_00114806 EFTA01263128 EFTA_00114807 EFTA01263129 Part 9. Information About Your Children Write your INS "A" - number here: A. How many sons and daughters have you had? For more information on which sons and daughters you should include and how to complete this section, see the Instructions. B. Provide the following information about all of your sons and daughters. If you need more space, use a separate sheet of paper.

Full Name of Son or Daughter	Date of Birth (Month/Day/Year)	INS "A" number (if child has one)	Country of Birth	Current Address (Street, City, State & Country)
	___/___/___	A___
	___/___/___	A___
	___/___/___	A___
	___/___/___	A___
	___/___/___	A___
	___/___/___	A___
	___/___/___	A___

## Part 10. Additional Questions Please answer questions 1 through 14. If you answer "Yes" to any of these questions, include a written explanation with this form. Your written explanation should (1) explain why your answer was "Yes," and (2) provide any additional information that helps to explain your answer. ## A. General Questions 1. Have you EVER claimed to be a U.S. citizen (in writing or any other way)? 2. Have you EVER registered to vote in any Federal, state, or local election in the United States? 3. Have you EVER voted in any Federal, state, or local election in the United States? 4. Since becoming a Lawful Permanent Resident, have you EVER failed to file a required Federal, state, or local tax return? 5. Do you owe any Federal, state, or local taxes that are overdue? 6. Do you have any title of nobility in any foreign country? 7. Have you ever been declared legally incompetent or been confined to a mental institution within the last 5 years? Form N.400 (Rev. 05/31/01)N Page 6 SDNY_GM_00000724 EFTA_00114808 EFTA01263130 ## B. Affiliations 8. a. Have you EVER been a member of or associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other place? □ Yes ☑ No b. If you answered "Yes," list the name of each group below. If you need more space, attach the names of the other group(s) on a separate sheet of paper.

Name of Group	Name of Group
1.	6.
2.	7.
3.	8.
4.	9.
5.	10.

9. Have you EVER been a member of or in any way associated (either directly or indirectly) with: a. The Communist Party? ☐Yes ☑No b. Any other totalitarian party? ☐Yes ☑No c. A terrorist organization? ☐Yes ☑No 10. Have you EVER advocated (either directly or indirectly) the overthrow of any government by force or violence? Yes No 11. Have you EVER persecuted (either directly or indirectly) any person because of race, religion, national origin, membership in a particular social group, or political opinion? Yes 12. Between March 23, 1933,and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with: ## C. Continuous Residence 14. Have you EVER failed to file a Federal, state, or local tax return because you considered yourself to be a "nonresident"? Since becoming a Lawful Permanent Resident of the United States: a. The Nazi government of Germany? 13. Have you EVER called yourself a "nonresident" on a Federal, state, or local tax return? b. Any government in any area (1) occupied by, (2) allied with, or (3) established with the help of the Nazi government of Germany? c. Any German, Nazi. or S.S. military unit, paramilitary unit, self-defense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp, or transit camp? SDNY_GM_00000725 EFTA_00114809 EFTA01263131 Part 10 Additional Questions (Continued) Write your INS "A" - number here: ## D. Good Moral Character For the purposes of this application, you must answer "Yes" to the following questions, if applicable, even if your records were scaled or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. 15. Have you EVER committed a crime or offense for which you were NOT arrested? Yes 16. Have you LVER been arrested, cited, or detained by any law enforcement officer including INS and military officers) for any reason? ☐ Yes ☑ Nr 17. Have you EVER been charged with committing any crime or offense? Yes No 18. Have you EVER been convicted of a crime or offense? Yes No 19. Have you EVER been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)? □Yes ☑No 20. Have you EVER received a suspended sentence, been placed on probation, or been paroled? Yes No 21. Have you EVER been in jail or prison? Yes No If you answered "Yes" to any of questions 15 through 21, complete the following table. If you need more space, use a separate sheet of paper to give the same information.

Why were you arrested, cited, detained, or charged?	Date arrested, cited, detained, or charged(Month/Day/Year)	Where were you arrested,cited, detained or charged?(City,State,Country)	Outcome or disposition of the arrest,citation,detention or charge(No charges filed,charges dismissed,jail,probation,etc.)

Answer questions 22 through 33. If you answer "Yes" to any of these questions, attach (1) your written explanation why your answer was "Yes," and (2) any additional information or documentation that helps explain your answer. ## 22. Have you EVER: b. been a prostitute, or procured anyone for prostitution? Yes No c. sold or smuggled controlled substances, illegal drugs or narcotics? $ \Box $ Yes $ \checkmark $ No d. been married to more than one person at the same time? Yes No e. helped anyone enter or try to enter the United States illegally? Yes No f. gambled illegally or received income from illegal gambling? [ ] Yes [✓] No g. failed to support your dependents or to pay alimony? 23. Have you EVER given false or misleading information to any U.S. government official while applying for any immigration benefit or to prevent deportation, exclusion, or removal? $ \Box $ Yes $ \checkmark $ No 24. Have you EVER lied to any U.S. government official to gain entry or admission into the United States? Yes No Form N-40 SDNY_GM_000007268 EFTA_00114810 EFTA01263132 Write your JNS "A"- number here: Part 10. Additional Questions (Continued) ## E. Removal, Exclusion, and Deportation Proceedings 25. Are removal, exclusion, rescission or deportation proceedings pending against you? Yes No 26. Have you EVER been removed, excluded, or deported from the United States? Yes No 27. Have you EVER been ordered to be removed, excluded or deported from the United States? $ \Box $ 25. Have you EVER applied for any kind of relief from removal, exclusion, or deportation? ## F. Military Service 29. Have you EVER served in the U.S. Armed Forces? 30. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces? 31. Have you EVER applied for any kind of exemption from military service in the U.S. Armed Forces? $ \Box $ Yes $ \checkmark $ No 32. Have you EVER deserted from the U.S. Armed Forces? ## G. Selective Service Registration 33. Are you a male who lived in the United States at any time between your 18th and 26th birthdays in any status except as a lawful nonimmigrant? $$\Box \text{Yes}$$ If you answered "NO", go on to question 34. If you answered "YES", provide the information below. If you answered "YES", but you did NOT register with the Selective Service System and are still under 26 years of age, you must register before you apply for naturalization, so that you can complete the information below: Date Registered (Month/Day/Year) Selective Service Number If you answered "YES", but you did NOT register with the Selective Service and you are now 26 years old or older, attach a statement explaining why you did not register. ## H. Oath Requirements (See Part 14 for the text of the oath) Answer questions 34 through 39. If you answer "No" to any of these questions, attach (1) your written explanation why the answer was "No" and (2) any additional information or documentation that helps to explain your answer. 34. Do you support the Constitution and form of government of the United States? 35. Do you understand the full Oath of Allegiance to the United States? 36. Are you willing to take the full Oath of Allegiance to the United States? 37. If the law requires it, are you willing to bear arms on behalf of the United States? 38. If the law requires it, are you willing to perform noncombatant services in the U.S. Armed Forces? 39. If the law requires it, are you willing to perform work of national importance under civilian direction? Form N-4*SDNY.GM100000727*: 9 EFTA_00114811 EFTA01263133 SDNY_GM_00000728 EFTA_00114812