Florida sexual offender registration form signed by Jeffrey Epstein, July 2012

EFTA00098670¶

Registration No: 480216¶

Person Number: 73274¶

FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM¶

Agency Name: Palm Beach County SO¶

***** Note: Your next ReRegistration month is January of 2013 *****¶

Registration For: July 2012 - SEXUAL OFFENDER¶

Reason For Registration
Initial Registration	Scheduled ReRegistration	Information Update	Early/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: United States Of America (usa)¶

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 Date of Departure: [blank]¶

☐ Temporarily leaving Florida to visit another state¶

☐ 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): Will be at temp address from 07/26/2012 till 07/30/2012¶

Previous Permanent Address	Current Permanent Address
	6100 Red Hook Quarters Ste B3
(Address Line 1)	(Address Line 1)
	Little St James Islands
(Address Line 2)	(Address Line 2)
	St Thomas VI 00802
(City) (State) (Zip)	(City) (State) (Zip)
County: End Date:	County: St Thomas Start Date: 07/19/2010
I do NOT have a permanent address at this time.

Page 1 of 6¶

2014-05-10 11:26:24 AM¶

EFTA00098671¶

Registration No: 480216¶

Person Number: 73274¶

Temporary Addresses ☐ I do NOT have a temporary addressPlease note: The registrant has reported additional temporary addresses not displayed here.
1.9 E 71st St(Street Address)	New York(City)		NY(State)	10021-4102(Zip)
County:New York	Dates you will be at this address:		To:
2.49 Zorro Ranch Rd(Street Address)	Stanley(City)		NM(State)	87056-9743(Zip)
County:Santa Fe	Dates you will be at this address:		To:
3.22 Avenue Foch 2dd(Street Address)	Paris(City)		YY(State)	00000(Zip)
County:Paris	Dates you will be at this address:		To:

Transient Addresses I do NOT have a transient address
1.
(Street Address or location)	(City)		(State) (Zip)
County:		Dates you will be at this address: From:	To:
2.
(Street Address or location)	(City)		(State) (Zip)
County:		Dates you will be at this address: From:	To:
3.
(Street Address or location)	(City)		(State) (Zip)
County:		Dates you will be at this address: From:	To:

Employment ☐ I am currently unemployed.
1. Employer:	Financial Trust Company	Occupation: Owner	Start Date: 7/26/2012
Address:	6100 Red Hook Quarter Ste B3 (Street Address)	St Thomas (City)	VI (State)	00802 (Zip)
County:	Saint Thomas	Contact Person:
2. Employer:		Occupation:	Start Date:
Address:			VI (State)	(Zip)
County:		Contact Person:
3. Employer:		Occupation:	Start Date:
Address:			VI (State)	(Zip)
County:		Contact Person:

Page 2 of 6¶

2014-05-10 11:26:25 AM¶

EFTA00098672¶

Registration No: 480216¶

Person Number: 73274¶

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) New York, NY 10021 (City)(State)(Zip)			1. Home
County: New York End Date:			2. Home
			3. Mobile
			4. Mobile
			5. Fax

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. 2005 (Year) Cadillac (Make) Other (Model) Black (Color/Color Scheme) Auto (Vehicle Type) HDJ142 (License Tag #) VI (State) This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

2. 2005 (Year) Cadillac (Make) Other (Model) Black (Color/Color Scheme) Truck (Vehicle Type) This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

3. 2002 (Year) Mercedes-benz (Make) 500 Series (Model) Black (Color/Color Scheme) Auto (Vehicle Type) C165SP (License Tag #) FL (State) This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

4. 2010 (Year) Chevrolet (Make) Surburban (Model) Black (Color/Color Scheme) Truck (Vehicle Type) BDLH78 (License Tag #) FL (State) This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

---

Vessels¶

☐ I do NOT own a vessel or houseboat.¶

Please note: The registrant has reported additional vessels not displayed here.¶

1. 2010 (Year) Other (Vessel Type) White (Color/Color Scheme) (Name of Vessel)

---

This vessel is: ☒ NOT used as a residence ☐ Used as a residence¶

2. 2000 (Year) Other (Vessel Type) White (Color/Color Scheme) (Name of Vessel)

---

This vessel is: ☒ NOT used as a residence ☐ Used as a residence¶

3. 2006 (Year) Jet-ski (Vessel Type) Black (Color/Color Scheme) (Name of Vessel) 1245L506 (Registration #) This vessel is: ☒ NOT used as a residence ☐ Used as a residence

4. 2008 (Year) Other (Vessel Type) White (Color/Color Scheme) Little C *(Name of Vessel) WJ1F1016B808 (Registration #) This vessel is: ☒ NOT used as a residence ☐ Used as a residence

Page 3 of 6¶

2014-05-10 11:26:25 AM¶

EFTA00098673¶

Person Number: 73274¶

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: ___ , ___ (State) (Zip) (Street Address) (City) County: ___ Employer: ___ Contact: ___

2. □ Student □ Employee □ Volunteer Start Date: ___ End Date: ___ University/School Name: ___ Campus: ___ Address: ___ , ___ (State) (Zip) (Street Address) (City) County: ___ Employer: ___ Contact: ___

3. □ Student □ Employee □ Volunteer Start Date: ___ End Date: ___ University/School Name: ___ Campus: ___ Address: ___ , ___ (State) (Zip) (Street Address) (City) County: ___ Employer: ___ Contact: ___

Cyber Communication Accounts ☐ I do NOT use any email addresses or Instant Message screen names. Please note: The registrant has reported additional online accounts not displayed here.
Email Addresses	Instant Message Screen Names
	Name:	Provider:
1. jeffreyepstein@live.com	1.
2. jeffreyepsteinorg@yahoo.com	2.
3. jeffreyepsteinorg@gmail.com	3.
4. jeevacation@me.com	4.
5. jeeproject@yahoo.com	5.

Adjudication Information
Date Adjudicated	Crime	Location of Adjudication/Conviction	Victim Information
1.		___，___(County)	☐Minor	☐Adult Gender: ___
2.		___，___(County)	☐Minor	☐Adult Gender: ___
3.		___，___(County)	☐Minor	☐Adult Gender: ___
4.		___，___(County)	☐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 4 of 6¶

2014-05-10 11:26:25 AM¶

EFTA00098674¶

Registration No: 480216¶

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 the person abides, lodges, or resides for 5 or more consecutive days.¶

“Temporary residence” means a place where the person abides, lodges, or resides, 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 the person’s permanent address or, for a person whose permanent residence is not in this state, a place where the person is employed, practices a vocation, or is enrolled as a student for any period of time in this state.¶

“Transient residence” means a place or county where a person lives, remains, or is located for a period of 5 or more days in the aggregate during a calendar year and which is not the person’s permanent or temporary address. The term includes, but is not limited to, a place where the person sleeps or seeks shelter and a location that has no specific street address.¶

FAILURE TO COMPLY WITH ANY OF THE FOLLOWING REQUIREMENTS IS A FELONY OF THE THIRD DEGREE (UNLESS OTHERWISE NOTED).¶

1. I MUST report in person to the local Sheriff’s Office within 48 hours of establishing or maintaining a residence in this state, within 48 hours of 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), or in the county of conviction within 48 hours of conviction if not under custody and/or supervision of DOC to register my temporary, transient, or permanent address and other information specified in statute. {F.S. 943.0435(2)(a); 775.21(6)(e)1}.

2. At initial registration, I MUST provide the following information to the department: name, date of birth, social security number, race, sex, height, weight, hair and eye color, photograph, home telephone number and any cellular telephone number, any electronic mail address and any instant message name required to be provided pursuant to paragraph s. 943.0435(4)(d) F.S., address of legal residence, address of any current temporary residence, if no permanent or temporary residence, any transient residence within the state, dates of any current or known future temporary residence within the state or out of state, occupation and place of employment, date and place of each conviction, fingerprints, and a brief description of the crime or crimes committed. {F.S. 943.0435(2)(b); 775.21(6)(a)1}.

3. Within 48 hours after the initial report required as stated in requirement #2 above, I MUST report in person to the driver’s 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’s license or identification card displaying one of the following designations: “775.21, F.S.” or “943.0435, F.S.”, unless a driver’s license or identification card with such designation was previously secured or updated. The sexual offender shall submit to the taking of a photograph for use by the department in maintaining current records of sexual offenders. {F.S. 943.0435(3); 775.21(6)(f)}.

4. Each time my driver’s 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’s license office to update my driver’s license or identification card and ensure that the driver’s license or identification card displays the designations as identified in requirement #3. {F.S. 943.0435(4)(a); 775.21(6)(g)1}.

5. If I am enrolled, employed 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, enrollment or employment status, including each change in enrollment or employment status, i.e. commencement or termination, in person at the Sheriff’s Office; OR, for a sexual offender on supervision with the Florida DOC or DJJ, this information must be reported to the sexual offender’s probation officer, within 48 hours after any change in status. {F.S. 943.0435(2)(b)2; 775.21(6)(a)b}.

6. I MUST report any electronic mail address or instant message name, prior to using such, during registration/reregistration or by providing all updates through the online system maintained by the Florida Department of Law Enforcement. {F.S. 943.0435(4)(d); 775.21(6)(g)4}.

7. 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); 775.21(6)(g)2}.

8. 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)(q)3}.

Page 5 of 6¶

2014-05-10 11:26:25 AM¶

EFTA00098675¶

Registration No: 480216¶

Person Number: 73274¶

9. I understand that my address will be verified by county, state or local law enforcement agencies. {F.S. 943.0435(6); 775.21(8)}.

10. If I intend on establishing a permanent, temporary, or transient residence in another state or jurisdiction 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. {F.S. 943.0435(7); 775.21(6)(i)}.

11. If I intend to establish a permanent, temporary, or transient residence in another state or jurisdiction other than the State of Florida 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. Failure to report this information is a felony in the second degree. {F.S. 943.0435(8); 775.21(6)(j)}.

12. I MUST report in person either twice a year (during the month of my birth and during the 6th month following my birth month) or four times a 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.

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 a year. All other sexual offenders are required to reregister twice a year.¶

I AM REQUIRED TO REREGISTER TWO TIMES A YEAR; I MUST REREGISTER AS NOTED BELOW.¶

{Pursuant to Sections 775.21(8)(a), 943.0435(14)(b), 944.607(13)(b), 944.4815(13)(a), Florida Statutes}¶

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

I AM REQUIRED TO REREGISTER FOUR TIMES A YEAR; I MUST REREGISTER AS NOTED BELOW.¶

{Pursuant to Sections 775.21(8)(a), 943.0435(14)(b), 944.607(13)(b), 944.4815(13)(a), Florida Statutes}¶

Month of Birth	I must reregister in the months of:		Month of Birth	I must reregister in the months of:
Jan	Jan, April, July & Oct		July	Jan, April, July & Oct
Feb	Feb, May, Aug, & Nov		Aug	Feb, May, Aug, & Nov
Mar	Mar, June, Sept & Dec		Sept	Mar, June, Sept & Dec
April	April, July, Oct & Jan		Oct	April, July, Oct & Jan
May	May, Aug, Nov & Feb		Nov	May, Aug, Nov & Feb
June	June, Sept, Dec & Mar		Dec	June, Sept, Dec & Mar

13. 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); 775.21(6)(a)1b}.

14. 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)}.

15. If I am employed, carry on a vocation, am a student, or become a resident of another state, I am on notice that I may have a requirement to register under the laws of that state.

16. I MUST maintain registration for the duration of my life. {F.S. 943.0435(11); 775.21(6)(I)}.

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:¶

Signature Required¶

Witnessed by Reporting Officer:¶

Printed Name: JEFFREY E EPSTEIN¶

Date: 07/26/2012¶

Signature Required¶

Printed Name:¶

Date: 07/26/2012¶

• OFFICIAL DOCUMENT DO NOT DESTROY*

***** NOTE: Your next ReRegistration month is January of 2013. *****¶

Page 6 of 6¶

2014-05-10 11:26:25 AM¶