EFTA01734336

S r. o' New von: os.seA or Deeeel s,stoe Sr. :es 0 So..", Sea- Si Aws NY 1221C To JEFFREY EPSTEIN t !TILE ST JAMES 6100 RED NOOK OuARTEPS SLATE 03 ST THOMAS vi ot3502 From Sex Offender Registry Unit NYS Division of CrImir?' Justice Serve:es RE Annual Address VesSoat on Sex Offender Registry Annual Address Verification Form Apni 9. 2014 Offender ID 33216 The Sex Offender Registration Act (SORA) requires you to review. update. and sign this Annual Address Verification Form and mail this form back to the Division of Criminal Justice Services within 10 days from receipt of this form You must do this whether or not you have reported updated information to parole probation or a law enforcement agency. If you attend. are enrolled at. reside at, or are employed at any institution of higher education, you must provide that information on this form You must also report your Internet service proyoder(s): all screen names. all e-mail addresses and all other information listed on the form If you are a level 2 Or 3 sex offender. you must report the name and address of all employers INSTRUCTIONS: Review each line of information on this form carefully. If you find any information that is incorrect or outdated. cross out incorrect or outdated information with a single line. Enter any Corrections or any now:additional information in the blank boxes provided. THIS FORM MUST BE SIGNED AND ALL PAGES RETURNED EVEN IF NONE OF THE INFORMATION HAS CHANGED. FAILURE TO RETURN ALL PAGES OF THIS FORM WITHIN 10 DAYS OF RECEIPT IS A FELONY AND MAY RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST. Please contact the Sex Offender Retstry at 518-457.3167 with any questions s firm OFFENDER INFORMATION LAST NAME FIRST SAME MIDDLE SSW LosTE % .EFCPEY E u... OTHER NAMES ERSTE N ,EFFREY ECWARD Enter any aliases. nick names or other names used in the following section PROT14 PROT0 IIIMIJIR11 ID PHYSICAL ATTRIBUTES EIRTHOATE HEIGHT WEIGHT HAIR EYES GLASSES 01#201195,3 600 Gray EOLO Mb. Z WOO (04 SCARS/MARKS/TATTOOS Enter any other scare/marks/tattoos PR MARY ADDRESS Primary address is the address where you live most of the time I NovetruSTREETwin CM alnwgwwrnewitasawECH-GatiwG6wWw. sr 7...wmf Moo ,..•a'v. r. ....• "r". C i :: • . ti . 1, .., S STATE ZO I CCwITY COWITIW w 06C2 VS A.. Cfal1PCW. I r. Piano/ Y 'MO Pon .Hiller mil.row "r• • t4 Nonni GO*Pati i Uftnn4Y PROT15 2194 PROT1 1°33216 - )73O747916 SECONDARY ADDRESS Secondary A.tldress s the address where you live some of the ti NUMEVASTNEETLIPT CITY 1 NE .IST ST NENYCOr. Yee -W000,4 WI 2/P COUNTY cousin •DC211,02 NN Yen' LS Yee camas,. c.. net PTCa• • miss mins* tine gay • ga nal., ^41 -' .. , " ..- v., ,; I Nit oy Car ) un ,e, • NOME*, rAT CiTY WM OZIVOWA. 2 2, 1, A ...,, c I- - -Th - y.' 1 STATE VI COUNTY COUNTRY eN Mae* Center. I En*, WON. • Cr•C'C. IVY ..• .r C. ftrt , %.• .1 3 NULTRIVSTAIIII/APT CITY ]SE EL BALLO NAY PALM (ANC- 4 e • (ca•CW4 Fn.. STATE ZIIT COUNTY COUNTA" FL >TAO 45 Met ere**, n.- Ppm I si 'In IMAMS 'Erne Teges• • <4.80.:0 NIP -.• • cy' r , 1* . ',1.1 No-, • PST , SPINmulf 4 NuMEMMITSEIIPART CITY 4$2011,0 AMC.' MO S7AA.EY Us. :2.11.104.• S'A't. ZIP GCS'S'', COMPORT Ca. VS map pna,T.• IMne fl-,..e Sol Ins *Urns I EMI? Ye* • Kr•t•CW. /SIV -.) • .._ C,4.11 . NM< OI CONIct i I.P.IVS.Iy En er any additional Secondary Address in the !ollowng section I WWII 01131122VAIT CITY STATE it Mary COUNTRY I I Le 'sore nes - .N 4 to oboes Alen s4 CA Ts amp.* AT a Coins of .o• Lys!, nil* Ps Are 2 NUMILUPSINEEILAST CITY ZIP COUNTY COMM EAU. VCs* • , e. .- PI pwi &boys Ali eLs L co we Tampa CA • Comps co wanner TAW a n•ell PROT16 PROT2 1033216 .00.07479:6 PO BOX ADDRESS PO Box Address is allowed if mail cannot be delivered tO the primary address PO Box Address must be approved by the Post Master and Law Enforcement Enter any PO BOX Information in the following section 11 .0 SOT CITY STATE Tn COUNTY COUNTRY EMPLOYMENT INFORMATION 1 IMPLOTEITS NAME IMASTASTRIEVAITT Ye•tmoem ' Sete. - r I. w . . • ,".. _ , 1 in l ' ' i' i CITY STATE I 1:. COUNTY COUNTRY or tratAS VI C0002 US mon coy.*** NO** of CORO* f UnvOrToT Enter any additional employment information in the following section 1 tfAiTLOYEN1 NAVE NUTONINSTRICT APT CITY STATE Ct• COUNTY CaPORY if ME at*. alCooss s ix, r• cam.. of a Color at yawn.' sew es non. 2 EMPLOYER% NAME NIAISIRSTITIETIATIt CM STATE I ZIP COUNTY COUNTRY i 1. "6 .Dow assma • 0. P'T Tr% T Tea 7,04404 a UnnTrwly ma TS TIM HIGHER EDUCATION INFORMATION Higher education includes any 2 or 4 year colleges Or any trade or vocational schools. En er any additional education intormaton in the following section I 5CHOCI. MAYO InulatitSTAtErrAinr CITY TAT[ I ZIP CCTOM COMTAY yl Dam 00 AnanSOCTI inneTtel z CNN:Meg ht. Oro M On w'4,1 VI O ."N5 IM € ^i221.0 CI Arra, ' 2 5540001 NANO NUNIKTOSTREIVAIT CITY ETATS ZIP COMTY COUNTRY Oates cl mnioce. Telocrenem co 1 TetTnym trea. CMG Ta On <nen an• CI imp ea I0 ENM44 CI Ain") Pips .4 0. • 1 PROT17 PROT3 'MINOil In "716 00000074 VEHICLE INFORMATION cc At, • , . Ilillainisin.rii vi (any YEAR vc.......s ...... v....sc. MAKE - MODEL i COLOR LIC PLATE STATE galetr amPrie46. 4•6•••••- -40•••• 9444199- I -Pe- I 2006 Unlit. 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Rave Rove Black ML071. NM V... •trOc1C.S P EA . 5 o• ' i PROT18 PROT4 I IIIINIIIIIII I 111111111 Enter an additional yeetele information in the following section YEAR MAKE MOIL COLOR UC PLATE STATE . S c t• f , ...." %:ZL r: • t...- -,. :... c-7-2-.t:- ti N. I r I \ f'• • I t -, - t ".1 " !": ..-_- - 1w ts• ••: , - •••:. L DRIVERS LICENSE INFORMATION DRIVERS LICENSE NUMBER ISSUING STATE 00000000233+ 3 VI %in :a. •.•, • Enter any additional driver's license information the foilow.ng sev.Ion DRIVER'S LICENSE NUMBER SSUING STAT PROT19 12198 PROT5 I;II~IIIIII,I~NIIIIIVI '° 33:I6 INTERNET INFORMATION SERVICE PROVIDER SERVICE PROVIDER 1 AT&T "... cote< -, TREE me. d • F.<;. t ...: - .., c , L i ORANGE TELECOM v.. .. CONIC.A.ST SORRY! TIME VI.PdPNER FACESOCK P NTEREST INDEED GRANT WATCH rdi.p....i...: etnntli MAPS mi., , <c 1- -cc-Ft k. r, PROT20 PROT6 el ''"16 1000000747916 SCREEN NAME SCREEN NAME L• • 4.• <0. Or W MI .aa..t EMAIL ADDRESS &MA& ADDRESS Mon tere.,,I. Mfg Crel•4*. Vra•• cr•Ces .6014 Ott' C••• lArie :VW' 0,1 Pne•SM 11 PROT21 PROT7 II) ICI IIIIIIIIIIIIfhlIIW 10000007479:6 Enter any additional Internet information in the following section SERVICE PROVIDER SCREEN NAME EMAIL ADDRESS PROT22 PROT8 I CERTIFY THAT THE INFORMATION ON THIS FORM IS COMPLETE AND ACCURATE I HAVE CROSSED OUT ALL INFORMATION THAT IS INCORRECT OR OUTDATED. I HAVE ADDED ALL CORRECTIONS AND ALL NEW INFORMATION. I UNDERSTAND THAT FAILING TO PROVIDE THIS INFORMATION OR PROVIDING FALSE INFORMATION ISA FELONY Sex Offenders Signatir 'r C 7-C I Sex Offender's Name(print) Date THIS FORM MUST BE SIGNED AND ALL PAGES RETURNED EVEN IF NONE OF THE INFORMATION HAS CHANGED. FAILURE TO RETURN ALL PAGES OF THIS FORM WITHIN 10 DAYS OF RECEIPT IS A FELONY AND MAY RESULT IN THE ISSUANCE OF A WARRANT FOR YOUR ARREST. 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