Florida Department of Law Enforcement Richard L. Swearingen Commissioner
| Criminal Investigations and Forensic Science Services Enforcement and Investigative Support | |
| Post Office Box 1489 | Jimm |
| Tallahassee, FL 32303-1489 | Nik' |
| 1-888-357-7332 | |
| www.fdle.state.fl.us | |
| Reason For Registration | |||
| Initial Registration | Scheduled ReRegistration | Information Update | Early/Late ReRegistration |
| Out of State Travel Information(Complete if permanent, temporary, or transient address is out of state) | |
| ☐Permanently leaving Florida to establish a residence in another state/country | Date of Departure: |
| ☐Temporarily leaving Florida to visit another state/country | |
| ☐Moving from another state to permanently establish a residence in Florida | Date of Arrival: |
| ☐Visiting from another state and establishing a temporary address in Florida | |
| ☐Other(please describe): | |
| Current Permanent Address | Future Permanent Address |
| 6100 Red Hook Quarters Ste B3 (Address Line 1) Little St James Islands (Address Line 2) St Thomas (City) VI (State) 00802 (Zip) | (Address Line 1) (Address Line 2) (City) VI (State) Zip County: St Thomas End Date: County: Start Date: |
| I do NOT have a permanent address at this time. | |
| Temporary Addresses I do NOT have a temporary addressPlease note: The registrant has reported additional temporary addresses not displayed here. | ||||
| 1.358 El Brillo Way(Street Address) | Palm Beach(City) | ,FL(State) | 33480-4730(Zip) | |
| County:Palm Beach | Dates you will be at this address: | From:07/26/2012 | To: | |
| Employment I am currently unemployed. | ||||
| 1. | Employer: Financial Trust Company | Occupation: Owner | Start Date: 07/26/2012 | |
| Address: 6100 Red Hook Quarter Ste B3 (Street Address) | St Thomas (City) | VI (State) | 00802 (Zip) | |
| County: Saint Thomas | Contact Person: | |||
| Mailing Address ☐ Same as Permanent ☐ Same as Temporary | Phone Numbers Please note: The registrant has reported additional phones not displayed here. ☐ I do NOT have or use any home or mobile phone numbers | ||
| 9 E 71st St (Address Line 1) | Phone Number: | Phone Type: | |
| (Address Line 2) | 1. Home | ||
| New York (City) NY (State) 10021 (Zip) | 2. Mobile | ||
| County: New York End Date: | 3. Fax | ||
| 4. Work | |||
| 5. Fax | |||
| Professional Licenses X I do NOT have any professional licenses. | |||
| 1. | (Number) | (Type) | (Issued by) |
| Month of Birth | I must reregister in: | Month of Birth | I must reregister in: | |
| Jan | Jan & July | July | Jan & July | |
| Feb | Feb & Aug | Aug | Feb & Aug | |
| Mar | Mar & Sept | Sept | Mar & Sept | |
| April | April & Oct | Oct | April & Oct | |
| May | May & Nov | Nov | May & Nov | |
| June | June & Dec | Dec | June & Dec |
| Month of Birth | I must reregister In: |
| Jan | Jan, April, July & Oct |
| Feb | Feb, May, Aug, & Nov |
| Mar | Mar, June, Sept & Dec |
| April | April, July, Oct & Jan |
| May | May, Aug, Nov & Feb |
| June | June, Sept, Dec & Mar |
| Month of Birth | I must reregister in: |
| July | Jan, April, July & Oct |
| Aug | Feb, May, Aug, & Nov |
| Sept | Mar, June, Sept & Dec |
| Oct | April, July, Oct & Jan |
| Nov | May, Aug, Nov & Feb |
| Dec | June, Sept, Dec & Mar |