Jeffrey Epstein FDLE sex offender registration form, July 2010

EFTA00098698¶

Registration No: 314643¶

Person Number: 73274¶

FDLE SEXUAL PREDATOR/OFFENDER REGISTRATION FORM¶

Agency Name: Palm Beach County SO¶

***** Note: Your next ReRegistration month is January of 2011 *****¶

Registration For: July 2010 - SEXUAL OFFENDER¶

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, 944.807, 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: ☐ 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 or temporary address is out of state)
☐ Permanently leaving Florida to establish a residence in another state	Date of Departure:7/20/2010
☐ Temporarily leaving Florida to visit another state
☐ 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):

Previous Permanent Address	Current Permanent Address
358 El Brillo Way (Address Line 1)		6100 Red Hook Quarters Ste B3 (Address Line 1) Little St James Island (Address Line 2)
Palm Beach	FL (State)	33480-4730 (Zip)	St Thomas
(City)		(City)	00802 (Zip)
County: Palm Beach End Date: 07/19/2010		County: St Thomas Start Date: 07/19/2010
☐ I am vacating this residence and have no other permanent or temporary residence as of this date:		☐ I have no other permanent or temporary residence at this time.

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EFTA00098699¶

Registration No: 314643¶

Person Number: 73274¶

Temporary Addresses □ I do NOT have a temporary address¶

1. 22 Avenue Foch 2dd (Street Address) Paris (City) ___, YY 00000 (State) (Zip) County: Paris ___ Dates you will be at this address: From: To:

2. 49 Zomo Ranch Rd (Street Address) Stanley (City) ___, NM 87056-9743 (State) (Zip) County: Santa Fe ___ Dates you will be at this address: From: To:

3. 9 E 71st St (Street Address) New York (City) ___, NY 10021-4102 (State) (Zip) County: New York ___ Dates you will be at this address: From: To:

4. 358 El Brillo Way (Street Address) Palm Beach (City) ___, FL 33480-4730 (State) (Zip) County: Palm Beach ___ Dates you will be at this address: From: To:

5. (Street Address) (City) ___, (State) (Zip) County: ___ Dates you will be at this address: From: To:

---

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)¶

(Address Line 2)¶

New York (NY 10021 (City) County: New York End Date:¶

Employment □ I am currently unemployed.¶

1. Employer: FTC Occupation: Owner Start Date: Address: 8100 Redhook Quarter Ste B3 (Street Address) St Thomas (City) YY 00802 (State) (Zip) County: Us Virgin Islands Contact Person:

2. Employer: Occupation: Start Date: Address: (Street Address) (City) (State) (Zip) County: Contact Person:

3. Employer: Occupation: Start Date: Address: (Street Address) (City) (State) (Zip) County: Contact Person:

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EFTA00098700¶

Registration No: 314643¶

Person Number: 73274¶

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. 2000 (Year) Chevrolet (Make) (State) Surburban (Model) Black (Color/Color Scheme) Truck (Vehicle Type)

   This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

2. 2007 (Year) Other (Make) (State) Other (Model) Black (Color/Color Scheme) Truck (Vehicle Type)

   This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

3. 2010 (Year) Chevrolet (Make) (State) Surburban (Model) Black (Color/Color Scheme) Truck (Vehicle Type)

   This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

4. 2005 (Year) Cadillac (Make) (State) Other (Model) Black (Color/Color Scheme) Truck (Vehicle Type)

   This vehicle is: ☒ NOT used as a residence ☐ Used as a residence

5. 2004 (Year) Chevrolet (Make) (State) Surburban (Model) Black (Color/Color Scheme) Truck (Vehicle Type)

   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. 2001 (Year) Other (Vessel Type) (Registration #) White (Color/Color Scheme) Lady G2 (Name of Vessel)

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

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

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

3. 1984 (Year) Other (Vessel Type) (Registration #) White (Color/Color Scheme) Lady G (Name of Vessel)

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

4. 2000 (Year) Other (Vessel Type) Red (Color/Color Scheme) Nana (Name of Vessel)

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

5. 1998 (Year) Other (Vessel Type) Blue (Color/Color Scheme) Lady K (Name of Vessel)

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

2014-05-08 8:15:36 PM¶

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EFTA00098701¶

Registration No: 314643¶

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: ___

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

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

Email Addresses	Instant Message Screen Names
	Name:	Provider:
1. jeeproject@yahoo.com	1.
2. jeevacation@gmail.com	2.
3.	3.
4.	4.
5.	5.

Adjudication Information¶

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

Were you or are you subject to registration or community notification in another state? ☐ Yes X No If Yes, in what state? ___¶

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EFTA00098702¶

Registration No: 314643¶

Person Number: 73274¶

NOTICE OF SEXUAL PREDATOR AND SEXUAL OFFENDER OBLIGATIONS¶

As a Sexual Predator (Florida Statute 775.21) or Sexual Offender (Florida Statute 943.0435, 944.607, or 985.481) where “Permanent residence” means a place where the person abides, lodges, or resides for 5 or more consecutive days, and “Temporary residence” means a place where the person abides, lodges, or resides 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, I understand that I am required by law to abide by the following: 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 the state of Florida or within 48 hours of release from custody and/or supervision of Department of Corrections (DOC), Department of Children and Family Services (DCFS) or Department of Juvenile Justice (DJJ) to register my temporary or permanent address.

2. Within 48 hours after the initial report required as stated in requirement #1 above, I must report in person the driver’s license office of the Department of Highway Safety and Motor Vehicles (DHSMV) to obtain 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 while under supervision of DOC, DCFS or DJJ and there have been no changes to my address, name or designation (Florida Statute 322.212).

3. I must report in person either twice a year (during the month of my birth and during the sixth 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.

NOTE: Unless otherwise notified by the Florida Department of Law Enforcement (FDLE), Sexual Offenders that were not adjudicated delinquent are required to reregister twice a year. All Sexual Predators are required to reregister four times a year and all Sexual Offenders adjudicated delinquent are required to reregister four times a year.¶

X I AM REQUIRED TO REREGISTER TWO TIMES A YEAR; I MUST REREGISTER AS NOTED BELOW. {Sexual Offenders {943.0435}, unless otherwise notified by FDLE}¶

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. {Sexual Predators (775.21) and Sexual Offenders (985.481), unless otherwise notified by FDLE}¶

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

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EFTA00098703¶

Registration No: 314643¶

Person Number: 73274¶

4. Within 48 hours, after any change of address in permanent or temporary residence, change of name due to marriage or other legal process, or when my driver’s license is subject to renewal, I must report that information in person to the driver’s license office of the Department of Highway Safety and Motor Vehicles to obtain and maintain a valid Florida driver’s license or identification card.

5. 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. I must also obtain and maintain a valid Florida driver’s license or identification card.

6. If I intend to establish residence in another state or jurisdiction other than the State of Florida, I must report in person to the local Sheriff’s Office to notify of my intention to do so within 48 hours prior to leaving.

7. If I later decide to remain in this state (see #6 above), I must report in person back to the local Sheriff’s Office to notify of my intention to remain in Florida. This report must occur within 48 hours after the date I indicated that I would leave. Failure to comply with this requirement is a felony of the second degree.

8. If I move from a permanent residence and do not have another permanent or temporary residence, I must report this change in person to the Sheriff’s Office within 48 hours. I must update all registration information and provide an address or location that I will occupy until I establish a residence.

9. If I later decide to remain at the permanent residence (see #8 above), I must report in person back to the Sheriff’s Office to notify of my intention. This report must occur within 48 hours after the date that I indicated that I would leave the permanent residence. Failure to comply with this requirement is a felony of the second degree.

10. I MUST respond to any address verification correspondence from FDLE within three weeks of the date of the correspondence.

11. If I am employed, carry on a vocation, am a student, or become a resident of another state I must also register in that state.

12. If I am enrolled, employed, or carrying on a vocation at an institution of higher education in this state, I shall also provide the name, address, and county of each institution, including each campus attended, and my enrollment or employment status. I shall report each change in enrollment or employment status in person at the Sheriff’s Office within 48 hours after any change in status.

13. I MUST report any electronic mail address or instant message name, prior to using such, during registration/reregistration and provide all updates through the online system provided by the Florida Department of Law Enforcement.

PLEASE READ CAREFULLY BEFORE SIGNING¶

As a Sexual Predator (Florida Statute 775.21) or Sexual Offender (Florida Statute 943.0435, 944.607 or 985.481), you are required by law to abide by those requirements listed on this form. By signing below, you acknowledge that you have read or have been read all the requirements on this form, AND that you understand these requirements.¶

YOU ARE REQUIRED TO REREGISTER EACH YEAR AT THE SHERIFF’S OFFICE IN THE MONTHS OF January AND July.¶

Under penalty of perjury I declare the above is true and correct.¶

Registrant:¶

Signature Required¶

Witnessed by Reporting Officer:¶

Signature Required¶

Date: 07/19/2010¶

Printed Name: JEFFREY E EPSTEIN¶

Printed Name:¶

Date: 07/19/2010¶

• OFFICIAL DOCUMENT DO NOT DESTROY *

***NOTE: Your next ReRegistration month is January of 2011. *****¶

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