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U.S. Department ofJustice
Federal Bureau of Investigation
In Reply, Please Refer to
26 Federal Plaza
File No. 50D-NY-3027571
USCIS
38 River Road
Essex Junction, Vermont 05479
Attention: Humanitarian Division
New York, New York 10278
August 9, 2022
RE:
: Continuous physical presence in the United States for criminal investigation
Dear USCIS:
cooperated in a federal investigation regarding Jeffrey Epstein and Ghislaine Maxwell.
In or about February of 2021,
counsel, Erica Dubno, informed our office of
intent to
depart briefly from the United States solely in connection with an E-2 visa, which
had been issued
bearing a March 25, 2021 expiration date.
was in lawful E-2 status at the time and eligible to extend that
status. She did not require our direct sponsorship to return to the United States by lawful means.
We informed
that she was required to return after the departure and that she was expected to be available
and physically present in the United States in connection with our ongoing investigation. She assured us of her
continued participation in the investigation upon her return.
did in fact return on February 15, 2021,
resuming her cooperation in the investigation of Jeffrey Epstein and Ghislaine Maxwell.
Elm
Assistant Special Agent in Charge
EFTA01653121
Supplement B, Delaration of Law Enforcement Officer for
Victim of Trafficking in Persons
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form 1-914
OMB No. 1615-0099
Expires 12/3112023
START HERE - Type or print in ink. This form should be completed by Federal, state,
local, or tribal law enforcement agencies for victims under the Victims of Trafficking and
Violence Protection Act (VTVPA), Public Law 106-386, as amended.
PART 1. Victim Information
I.
Full Legal Namc
Family Name (Last Name) Given Name (First Name)
Middle Name (if any)
2.
Other Names Used
Provide any other names you have used since birth, including aliases, maiden names,
and nicknames. If you need extra space to complete this section, use the space
provided in Part 9. Additional Information.
Family Name (Last Name)
Given Namc (First Name)
Middle Name (if any)
3.
5.
6.
Date of Birth (dd/mm/yyyy)
4.
Gender or Sex
K Male ❑X Female K Other
Alien Registration Number (A-Number) (if any)
► A-
U.S. Social Security Number (SSN) (if any)
Part 2. Agency Information
I.
Name of Certifying Agency
Federal Bureau of Investigations
2.
Namc of Certifying Official
'Amanda Young
3.
Title of Certifying Official
Special Agent
4.
Division/Office of Certifying Official
'New York Field Office
5.
Agency Mailing Address
Street Number and Name
For USCIS Use Only
Returned
Date
Date
Resubmitted
Date
Date
Reloc Sent
Date
Date
Reloc Rec'd
Date
Date
Receipt
Remarks
26 Federal Plaza
City or Town
New York
IMPS ZIP Co* Loging2
Apt. Ste. Flr.
State
NY
6.
Daytime Telephone Number
7.
Fax Number
Number
ZIP Code
10278
Form 1-914. Supplement B Edition 12/02/21
Page
EFTA01653122
Part 2. Agency Information (continued)
8.
Agency Type
0 Federal
9.
Case Status
0 On-going
D State
0 Completed
D Local
0 Tribal
10.
Certifying Agency Category
K Judge
0 Law Enforcement
O Prosecutor
0 Other
II.
Case Number
12.
FBI or SID Number
Part 3. Statement of Claim
1.
The applicant is or has been a victim of a severe form of trafficking in persons. Specifically, he or she is a victim of: (Select all
that apply. Base your analysis on the victimization the applicant experienced rather than on the specific violations charged, the
counts on which convictions were obtained, or whether any prosecution resulted in convictions. Note that the definitions that
control this analysis are not the elements of criminal offenses, but arc those set forth at 8 CFR 214.11(a).)
Sex trafficking in which a commercial sex act was induced by force, fraud, or coercion. Sex trafficking means the
0 recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a
commercial sex act.
0 Sex trafficking and the victim is under 18 years of age.
RA The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force,
r= fraud, or coercion for subjection to involuntary servitude, peonage, debt bondage, or slavery.
0 Other, specify on attached additional sheets.
2.
Please describe the victimization the applicant's claim is based on and identify the relationship between that victimization and
the crime investigated or prosecuted. Attach the results of any name or database inquiry performed in the investigation of the
case, as well as any relevant reports and findings. Include relevant dates, etc. Attach additional sheets, if necessary.
Applicant was recruited, harbored, and obtained by Jeffrey Epstein and others for
purposes of a coercive sexual relationship. On numerous occasions, Jeffrey Epstein
coerced, threatened, and forced Applicant into submission for purposes of him
committing sex acts with or unto her. Applicant shared pictures of injuries she
sustained as a result of physical abuse/encounters with Mr. Epstein.
3.
las the applicant expressed any fear of retaliation or revenge if removed from the United States? If yes, explain. Attach
additional sheets, if necessary.
Applicant informed us that she and some of her family members in their native
Slovakia, directly and indirectly, have received threats during Applicant's
participation in the investigation and prosecution of criminal charges against
suspects/defendants Jeffrey Epstein and Ghislaine Maxwell. Applicant expressed fear
of retaliation or revenge by individuals connected to or implicated in the alleged
criminal acts of Mr. Epstein and Ms. Maxwell. Applicant has expressed fear of serious
harm by such individuals if she were to be removed from the United States.
Form 1-914, Supplement B Edition 12/02/21
Page 2
EFTA01653123
Part 3. Statement of Claim (Continued)
4.
Provide the date(s) on which the acts of trafficking occurred.
Date (mm/dd/yyyy)
Not. X03-2018
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
5.
List the statutory citation(s) for the acts of trafficking being investigated or prosecuted, or that were investigated or prosecuted.
18 USC 371; 18 USC 1591(a), (b); 18 USC 1623; USC 2423(a) ; NYPL 130.55
6.
Provide the date on which the investigation or prosecution was initiated.
Date (mm/dd/yyyy)
12/06/2018
7.
Provide the date on which the investigation or prosecution was completed.
Date (mm/dd/yyyy)
06/28/2022
Part 4. Cooperation of Victim
The applicant:
RA Has complied with requests for assistance in the investigation/prosecution of the crime of trafficking. (If you select
' .I Item A., provide an explanation below in Item Number 2.)
B
u
.—. Has failed to comply with requests to assist in the investigation/prosecution of the crime of trafficking. (If you select
Item B., provide an explanation below in Item Number 2.)
C. El Has not been requested to assist in the investigation/prosecution of any crime of trafficking.
D. K Has not yet attained the age of 18.
A.
E. El Other, specify on attached additional sheets.
2.
If you selected Item A. or Item B. above, provide an explanation for your selection.
participated in several telephonic and in person meetings with our
office concerning our investigation of criminal charges against Jeffrey Epstein and
Ghislaine Maxwell.
responded to questions asked of her about alleged
criminal activities by Mr. Epstein and Ms. Maxwell.
Part 5. Family Members Implicated In Trafficking
Arc any of the applicant's family members believed to have been involved in his or her trafficking to the United States?
❑yes El No
If you answered "Yes" to Item Number I., list the relative(s) and describe the involvement. Attach additional sheets if
necessary.
Full Name
Relationship
Involvement
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Fonn 1414, Supplement B Edition 12/02/21
Page 3
EFTA01653124
Part 6. Attestation
Based upon investigation of the facts, I certify, under penalty of perjury, that the above noted individual is or has been a victim of a
severe form of trafficking in persons as defined by the VTVPA. I certify that the above information is true and correct to the best of
my knowledge, and that I have made, and will make, no promises regarding the above victim's ability to obtain a visa from U.S.
Citizenship and Immigration Services (USCIS), based upon this certification. I further certify that if the victim refuses to comply with
reasonable requests for assistance in the investigation or prosecution of the acts of trafficking of which he/she is a victim, I will notify
USCIS.
I.
Sjgnature of Law Enforcement Officer (identified in Part 2.)
0
2.
i
of Supervisor of Certifying Officer
S
3.
Printed Name of Supervisor
(rice
Date of Si
ture (mm/ddlyyyy)
Oa re la-o9
Date of Si
ture (mm/dd/yyyy)
cZro IQ a
Form I-914. Supplement 8 Edition 12102/21
Page 4
EFTA01653125