_ APR-16-2010 13:18 FBI ICRC WINCHESTER VA P.004 a as Federal Bureau of Investigatio@@Privacy Waiver and Certification of Idontit AD Page 1 of 1 | Complete. ulgn, and.malt (orginal sipnature needed) : ; P isi. OS. Departmont of Justice Loy emg CONG iz Lye # ia y\ 5 ae TF. Mi: epee” ae ; “a a Federal Bureau of Investigation —_-_--ernrern a tL ; Privacy Walver and Certification of identity pullteme: Jeliney E- Epstein Alles OS Rr Curent Address: 3.9 § i Palm Beach, FL 33480 pasorsits 1/20/1953 ruortm Kings County, New York sede! Socutty Number optional OPO-44—-3348 H ; @ptonat: Sits hired employments, 6f6,, which may gapiet tia FB! In locating the raquested information) . ; eset EAC tt tt eet Rte i tI et : _—ecccet - “ ttt NT 4 t boreby wulve my dghtao privacy, and | anthorize the FU! fo release uny and all Information rateting to ma to: (Name, eutdowse phone of ottorney Of Ulter desloneo) ‘ tt tlt Ne Undor penta E 1 Choad Phaz fad ( antes Ee Fi OSE ON tesa auton d, od dunt camieadies 0 ; providions of 726 18, United Stotky Code (U.5.C.). Secon T0at by 6 (iie.of not mote then $10,000 of by Imertzonmen| of not more than five years, oy both: and thal i requesting oveblainho any secatdlp) Under false prefonxes Ix punhehablo under (he providlon« of TlUy 6. U.6.C., Section S526 (9(3) ox a mniedamasner ond by a fino of nol more ty6n 35,009. : | ‘Signature: : Dele; / SH g | t _ | ; ; : _ 4 ! ; i 4 ! : . ' q ; . , if ' q : t | \ . i { 3 , . » littp://foia.fbi.gov/waiver-him 12/29/2009 t. i | i . | 14 | ; 3 TOTAL P.004 HOUSE_OVERSIGHT_021676