EFTA00098607 Registration No: 859077 Person Number: 73274 # FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM # Agency Name: Palm Beach County SO ***** Note: Your next ReRegistration month is July of 2016 ***** Registration For: June 2016 - SEXUAL OFFENDER
Reason For Registration
Initial RegistrationScheduled ReRegistrationX Information UpdateEarly/Late ReRegistration
# Registrant Information Name: JEFFREY E EPSTEIN *SSN: DOB: Race: White Sex: Male (First Middle Last, Suffix) *Disclosure of your Social Security Number (SSN) is mandatory pursuant to Florida law, sections 775.21, 943.0435, 944.607, 985.481, F.S., and federal law, 42 USC 16901, et seq. Use of your SSN is for the purposes of identification, FDLE may share the information with the other agencies for the same purpose. FL DL or ID Card #: E123425530200 Height: 6' 00" Weight: 180 lbs Hair: Grey Eyes: Blue Place of Birth: ___ Immigration Status: Not Applicable Currently on Probation/Parole: [X] No [ ] Yes Probation Type: □ State Officer Name: Phone: () State □ Federal Officer Name: Phone: () City □ County Officer Name: Phone: () County 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: [blank] ☐ Temporarily leaving Florida to visit another state/country ☐ Moving from another state to permanently establish a residence in Florida Date of Arrival: [blank] ☐ Visiting from another state and establishing a temporary address in Florida ☐ Other (please describe): [blank]
Current Permanent AddressFuture 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) County: St Thomas End Date:(Address Line 1) (Address Line 2) (City) VI (State) 00802 (Zip) County: Start Date:
I do NOT have a permanent address at this time.
Page 1 of 6 2016-06-29 2:48:43 PM EFTA00098608 ## Registration No: 859077 Person Number: 73274 # Temporary Addresses □ I do NOT have a temporary address Please 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: ___ # Transient Addresses *I do NOT have a transient address* 1. ___, ___ (State) ___ (Zip) (Street Address or location) (City) County: ___ Dates you will be at this address: From: ___ To: ___
Employment I am currently unemployed.
1.Employer:Financial Trust CompanyOccupation:Owner Start Date:07/26/2012
Address:6100 Red Hook Quarter Ste B3(Street Address)St Thomas(City)VI(State) 00802(Zip)
County:Saint ThomasContact Person:
Mailing Address ☐ Same as Permanent ☐ Same as TemporaryPhone 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. (561) 655-7626Home
New York (City)2. (212) 533-3739Mobile
3. (561) 655-3572Fax
4. (304) 775-8135Work
County: New York End Date:5. (505) 938-2924Fax
# Campus Activity I am NOT a student, employee, or volunteer at a university or institution of higher learning. 1. ☐ Student ☐ Employee ☐ Volunteer Start Date: ___ End Date: ___ University/School Name: ___ Campus: ___ Address: ___ , ___ (Street Address) (City) (State) (Zip) County: ___ Employer: ___ Contact: ___
Professional Licenses I do NOT have any professional licenses.
1.(Number)(Type)(Issued by)
Page 2 of 6 2016-06-29 2:48:44 PM EFTA00098609 Registration No: 859077 Person Number: 73274 # Passport I do NOT have a Passport information. 1. ___ (Number) ___ (Issue Date) ___ (Expiration Date) ## Email/Internet Identifiers I do NOT use any email addresses or Internet identifiers. Please note: The registrant has reported additional online accounts not displayed here. | Email Addresses | Internet Identifiers | | :--- | :--- | | 1. columbiadental1@yahoo.com | Name: Provider: | | 2. jeepproject@yahoo.com | 1. ___ ___ | | 2. ___ ___ | 2. ___ | ## Scars/Marks/Tattoos I do NOT have any Scars, Marks or Tattoos. 1. ___ (Type) ___ (Location) ___ (Description) ___ 2. ___ (Type) ___ (Location) ___ (Description) ___ ## Vehicles I do NOT own or use a vehicle, RV, trailer or mobile home. Please note: The registrant has reported additional vehicles not displayed here. 1. **2013 Ford** (Make) EXPEDITION (Model) Black (Color/Color Scheme) Truck (Vehicle Type) 522rzz NM (State) This vehicle is: ☑ NOT used as a residence ☐ Used as a residence ☐ Owned by registrant (License Tag #) 2. **2012 Cadillac** (Make) OTHER (Model) Black (Color/Color Scheme) Truck (Vehicle Type) fx3455 NY (State) This vehicle is: ☑ NOT used as a residence ☐ Used as a residence ☐ Owned by registrant (License Tag #) ## Vessels I do NOT own a vessel or houseboat. Please note: The registrant has reported additional vessels not displayed here. 1. **2011 Other** (Vessel Type) White (Color/Color Scheme) (Name of Vessel) yes This vessel is: ☑ NOT used as a residence ☐ Used as a residence (Registration #) ## Adjudication Information Date Adjudicated Crime Location of Adjudication/Conviction Victim Information 1. ___ (County), (State) Minor □ Adult Gender: ___ 2. ___ (County), (State) Minor □ Adult Gender: ___ Were you or are you subject to registration or community notification in another state? ☐ Yes ☐ No If Yes, in what state? ___ Page 3 of 6 2016-06-29 2:48:44 PM EFTA00098610 Registration No: 859077 Person Number: 73274 ## NOTICE OF SEXUAL PREDATOR AND SEXUAL OFFENDER OBLIGATIONS As a sexual predator (F.S. 775.21) or sexual offender (F.S. 943.0435; 944.607; or 985.4815) I understand that I am required by law to abide by the following: "Permanent residence" means a place where I abide, lodge, or reside for 5 or more consecutive days. "Temporary residence" means a place where I abide, lodge, or reside, including, but not limited to, vacation, business, or personal travel destinations in or out of this state, for a period of 5 or more days in the aggregate during any calendar year and which is not my permanent address or, if my permanent residence is not in this state, a place where I am employed, practice a vocation, or am enrolled as a student for any period of time in this state. "Transient residence" means a county where I live, remain, or am located for a period of 5 or more days in the aggregate during a calendar year and which is not my permanent or temporary address. The term includes, but is not limited to, a place where I sleep or seek shelter and a location that has no specific street address. "Internet Identifier" means all electronic mail, chat, instant messenger, social networking, application software, or similar names used for Internet communication. Use of my date of birth, social security number, or PIN as an Internet identifier waives the disclosure exemption for such personal information. "Vehicles owned" means any motor vehicle as defined in s. 320.01, which is registered, co-registered, leased, titled, or rented by me; a rented vehicle that I am authorized to drive; or a vehicle for which I am insured as a driver. The term also includes any motor vehicle as defined in s. 320.01, which is registered, co-registered, leased, titled, or rented by a person or persons residing at my permanent residence for 5 or more consecutive days. 1. Within 48 hours of establishing or maintaining a residence in this state, or release from custody and/or supervision of the Department of Corrections (DOC), the Department of Children and Family Services (DCFS), or the Department of Juvenile Justice (DJJ), I MUST report In person to the local sheriff's office to register my temporary, transient, or permanent address and other information specified in statute. If I am convicted of an offense that requires registration and am not under custody and/or supervision of DOC I must report In person to the sheriff's office in the county of conviction within 48 hours of the conviction.{F.S. 943.0435(2)(a); 775.21(6)(e)}. ## FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY. 2. At registration, I MUST provide the following information to the department: name; date of birth; social security number; race; sex; height; weight; tattoos or other identifying marks; hair and eye color; photograph; all home telephone numbers and cellular telephone numbers; all electronic mail addresses and all Internet identifiers required to be provided pursuant to paragraph s. 943.0435(4)(e) F.S. or s. 775.21(6)(g)5 F.S.; address of all permanent and legal residences; address of any current temporary residence; any transient residence within the state; address, location, description and dates of any current or known future temporary residence within the state or out of state; occupation and place of employment; make, model, color, vehicle identification number (VIN), and license tag number of all vehicles owned; date and place of each conviction; fingerprints; palm prints; and a brief description of the crime or crimes committed. I must also produce my passport (if I have one). If I am an alien, I must produce or provide information about documents establishing my immigration status. I must also provide information about all professional licenses I have. {F.S. 943.0435(2)(b); 775.21(6)(a)1}. ## FAILURE TO REPORT AS REQUIRED IS A THIRD DEGREE FELONY. 3. Within 48 hours after the initial registration of information as required in #2 above, I MUST report In person to the driver license office of the Department of Highway Safety and Motor Vehicles (DHSMV) and provide proof of initial registration as a sexual offender or predator to secure or renew a valid Florida driver license or identification card displaying one of the following designations: “SEXUAL PREDATOR” or “943.0435, F.S.” unless a driver license or identification card with such designation was previously secured or updated. I must submit to the taking of a photograph for use by the department in maintaining current records of sexual offenders/predators. {F.S. 943.0435(3); 775.21(6)(f)}. FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A THIRD DEGREE FELONY. 2016-06-29 2:48:44 PM Page 4 of 6 EFTA00098611 Registration No: 859077 Person Number: 73274 4. Each time my driver license or identification card is subject to renewal, or within 48 hours after any change in my permanent, temporary, or transient residence or change in name made by marriage or other legal process, I MUST report In person to a driver license office to update my driver license or identification card and ensure that the driver license or identification card displays the designations as identified in #3 above. If I am unable to secure or update a driver license or identification card with DHSMV, I must also report any change of my residence or name within 48 hours after the change to the sheriff's office in the county where I reside or am located and provide confirmation that I reported the information to DHSMV. {F.S. 943.0435(4)(a); 775.21(6)(g)1}. ## FAILURE TO MAINTAIN, ACQUIRE, OR RENEW A DRIVER LICENSE OR ID CARD AS REQUIRED IS A THIRD DEGREE FELONY. 5. If I am enrolled, employed, volunteering or carrying on a vocation at an institution of higher education in Florida, I MUST provide the name, address and county of each institution including each campus attended, and my enrollment, volunteer, or employment status. Each change in enrollment, volunteer, or employment status, i.e. commencement or termination, MUST be reported in person at the sheriff's office within 48 hours after any change in status. OR, if I am on supervision with the Florida DOC or DJJ, this information MUST be reported to my probation officer within 48 hours after any change in status. {F.S. 943.0435(2)(b)2; 943.0435(14)(c)2; 775.21(6)(a)1.b; 775.21(8)(a)2}. FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 6. Before using any electronic mail address or Internet identifier I MUST report it using the online system maintained by the Florida Department of Law Enforcement or in person at the sheriff's office. {F.S. 943.0435(4)(e); 775.21(6)(g)5}. FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 7. I MUST report any changes in vehicles owned within 48 hours **In person** at the sheriff's office. {F.S. 943.0435(2)(b)3; 775.21(6)(a)1.c}. ## FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 8. If I vacate a permanent, temporary, or transient residence, and do not have another permanent, temporary, or transient residence, I MUST report in person to the sheriff's office in the county where I am located within 48 hours. {F.S.943.0435(4) (b)1;775.21(6)(g)2.a}. FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 9. If I report that I have vacated a permanent, temporary, or transient residence and then remain at that residence, I MUST report in person to the Sheriff's Office where I reported vacating my residence. Failure to report this information is a felony of the second degree. {F.S. 943.0435(4)(c); 775.21(6)(g)3}. FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY 10. I understand that my address may be verified by county, state, or local law enforcement agencies. {F.S. 943.0435(6); 775.21(8)}. 11. If I intend on establishing a permanent, temporary, or transient residence in another state, jurisdiction, or country other than the State of Florida, I MUST report in person to the sheriff's office in the county of my current residence within 48 hours before the date that I intend to leave this state to establish residence in another state, or jurisdiction, or within 21 days before my planned departure date if the intended residence of 5 days or more is outside of the United States. {F.S. 943.0435(7); 775.21(6)(i)}. ## FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 12. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida, or another country, and later decide to remain in this state, I MUST report in person to the sheriff's office to which I reported my intention of leaving the state within 48 hours after the intended departure date. {F.S. 943.0435(8); 775.21(6)(j)}. FAILURE TO REPORT THIS INFORMATION IS A SECOND DEGREE FELONY. 13. I MUST report **in person** either **two times per year** (during the month of my birth and during the 6th month following my birth month) or **four times per year** (once during the month of my birth and every 3rd month thereafter), **depending upon my offense/designation**, to the sheriff's office in the county in which I reside or am otherwise located to reregister, unless otherwise notified by FDLE. FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. Page 5 of 6 2016-06-29 2:48:44 PM EFTA00098612 Registration No: 859077 Person Number: 73274 All sexual predators, sexual offenders convicted for offenses specified in F.S. 943.0435(14)(b), and juvenile sexual offenders required to register per F.S. 943.0435(1)(a)1.d are required to reregister four times per year. All other sexual offenders are required to reregister two times per year. I AM REQUIRED TO REREGISTER TWO TIMES PER YEAR; I MUST REREGISTER AS NOTED BELOW. {Pursuant to Sections 943.0435(14)(a), 944.607(13)(a), Florida Statutes}
Month of BirthI must reregister in:Month of BirthI must reregister in:
JanJan&JulyJulyJan&July
FebFeb&AugAugFeb&Aug
MarMar&SeptSeptMar&Sept
AprilApril&OctOctApril&Oct
MayMay&NovNovMay&Nov
JuneJune&DecDecJune&Dec
I AM REQUIRED TO REREGISTER FOUR TIMES PER YEAR; I MUST REREGISTER AS NOTED BELOW. {Pursuant to Sections 775.21(8)(a), 943.0435(14)(b), 944.607(13)(b), 985.4815(13)(a), Florida Statutes}
Month of BirthI must reregister In:Month of BirthI must reregister In:
JanJan, April, July & OctJulyJan, April, July & Oct
FebFeb, May, Aug, & NovAugFeb, May, Aug, & Nov
MarMar, June, Sept & DecSeptMar, June, Sept & Dec
AprilApril, July, Oct & JanOctApril, July, Oct & Jan
MayMay, Aug, Nov & FebNovMay, Aug, Nov & Feb
JuneJune, Sept, Dec & MarDecJune, Sept, Dec & Mar
14. In addition to the registration months listed above, I MUST report in person to the sheriff's office in the county in which I am located within 48 hours of establishing a transient residence and thereafter must report in person every 30 days to the sheriff's office in the county in which I am located while I maintain a transient residence. I MUST provide the addresses and locations where I maintain a transient residence. {F.S. 943.0435(4)(b)2; 775.21(6)(g)2.b}. FAILURE TO REPORT IS A THIRD DEGREE FELONY. 15. If I live in another state, but work or attend school in Florida, I MUST register my work or school address as a temporary address within 48 hours by reporting in person to the local sheriff's office. {F.S. 943.0435(2)(a); 943.0435(2)(b)2; 943.0435(14)(c)2; 775.21(6)(a)1.b; 775.21(6)(e)1; 775.21(8)(a)2}. FAILURE TO REPORT THIS INFORMATION IS A THIRD DEGREE FELONY. 16. I MUST respond to any address verification correspondence from FDLE within three weeks of the date of the correspondence. {F.S. 943.0435(14)(c)4; 775.21(10)(a)}. FAILURE TO RESPOND AS REQUIRED IS A THIRD DEGREE FELONY. 17. If I am employed in, carry on a vocation in, am a student in, or become a resident of another state or jurisdiction, I am on notice that I may have a requirement to register under the laws of that state. 18. I MUST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(I)}. 19. KNOWINGLY PROVIDING FALSE REGISTRATION INFORMATION BY ACT OR OMISSION IS A THIRD DEGREE FELONY. {F.S. 943.0435(14)(c)4; 775.21(10)(a)}. REGISTRATION INFORMATION IS PUBLISHED ON THE FDLE PUBLIC SEXUAL PREDATOR AND OFFENDER WEBSITE. ## PLEASE READ CAREFULLY BEFORE SIGNING As a sexual predator (Florida Statute 775.21) or sexual offender (Florida Statute 943.0435, 944.607, or 985.4815), I am required by law to abide by the requirements listed on this form. BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ OR HAVE BEEN READ THE REQUIREMENTS ON THIS FORM, AND THAT I UNDERSTAND THESE REQUIREMENTS. Under penalty of perjury I declare the above is true and correct. YOU ARE REQUIRED TO REREGISTER EACH YEAR AT THE SHERIFF'S OFFICE IN THE MONTHS OF January AND July. # Registrant: Witnessed by Reporting Officer: Signature Required Printed Name: JEFFREY E EPSTEIN Signature Required Date: 06/29/2016 Printed Name: Date: 06/29/2016 - OFFICIAL DOCUMENT DO NOT DESTROY* ***** NOTE: Your next ReRegistration month is July of 2016. ***** Page 6 of 6 2016-06-29 2:48:44 PM