Scanned Document Collection

Page 1 of 4

wo U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS OMB APPROVAL NO 1405-0022 EXPIRATION DATE 12-31-2013 Please Print Legibly Using Black Ink Only ESTIMATED BURDEN 43 MIN Attention: Read WARNING on page 1 of instructions Please select the document(s) for which you are applying: U.S. Passport Book US Passport Card Both see 12 page to for 2 Pa Bock (Standard 52age Book (No வ the pa andard) 115457872 Name Last D OOP DOTS Code, MAXWELL End. F Exp. First Middle GHISLAINE NOELLE 2. Date of Birth (mm/dd/yyyy) 3. Sex 4. Place of Birth (City & State in the US or City & Country as it is presently known) 5. Social Security Number 6 Email Address (eg. my_wangbomavi.com Primary Contact Phone Number 8. Mailing Address: Line 1: SrBBORIDE, PO Box, or Address Line 2: Carly el Ament Company, Sul Unit Ruilding, Fino in Care Of or Attention ifplicable (eg in Care Of-Jane Doe, Apt #100) Reproduction Co try if outside the Unid States City 1. Last an omner names you have used. (Examples Birth Name, Malon Previous Marriage, Legal Name Change. Attach additional pages if needed) B. 10. Passport Book and/or Passport Card Information Your name as listed on your most recent passport book and/or passport card GHISLAINE NOELLE MAXWELL Most recent passport book number Issue date (mm/dd/yyyy) 12/04/2002 Most recent passport card number Issue date (mm/dd/yyyy) 11. Name Change Informat Complete if auto is dent then last pactant book or nassport card Chard by Man ace of Nne Change CState) Date mm/dayyy) ged b CouOm Please submit a certified copy of your manage certificate or court order to support your name change CONTINUE TO PAGE 2 YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW declare under penalty of perjury sil of the folowing 1) I am a otzen or non-citizen national of the United States and have not, since acquiring US citizenship or nationality, performed any of the acts isted under "Acts or Conditions on the reverse side of this application (unless explanatory statement is attached); 2) the statements made on the application are and conect 3) I have not knowingly and wilfully made fase statements or included faise documents in support of this application; 4) the photograph submited with this appion is a genuine current photograph of me and 5) I have read and understood the warming on page one of the instructions to the application form 4/09/12 Applicants Signature FOR ISSUING OFFICE ONLY PPT C PPT SR Mariage Certificate Date of Mariage Placed Court Order Date Fled Court From Prohibited To Other Atached For Issuing Office Only k Fe 110 Cd Fee 660 Postage Other CK DS 82 B 12 2010 1- Page 1 of 2

DS-82 12-2010

00006885-0776

https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020

EFTA00038787

# Scanned Document Collection

Page 2 of 4

Date of Birth (mm/dd/yyyy)
Name of Applicant (Last First & Middle)
MAXWELL, GHISLAINE NOELLE
12. Height 5ft. 8in. 13. Hair Colc Brown 14 ye Color Brown 15. Occupation CONSULTANT 16. Employer or School fapplicable) SELF EMPLOYED
17. Additional Contact Phone Number Home Cel
Home C
Won

18. Permanent Address: IPO. Box is listed under Mailing Address or residence is different from Mailing Address Apartment/Unit
Street/RFD #or URB (No P.O. Box)

State Zip Code
City

19. Emergency Contact Provide the information of a person not traveling with you to be contacted in the event of an emergency Apartment/Unit
Address: Street RFD # or P.O. Box
Name

City Late Zip Code Ph ASSISTANT
00006885-0777

20. Travel Plans
Date of Trip (mm/dd/yyyy) Duration of Trip Countries to be visited
04/12/2012 2 WEEKS FRANCE AT #7

STOP! YOU HAVE COMPLETED YOUR APPLICATION
BE SURE TO SIGN AND DATE PAGE ONE

Disclos

DS 82 B 12 2010 2
Page 2 of 2
DS-82 12-2010

https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020

EFTA00038788

# Scanned Document Collection (cont.)

Scanned Document Collection

Page 3 of 4

22 Ave S204 Nawk NY 1000]
"authorized 616-2258

Letter of Authorization

To: The US Passport Office

Reproduction 00006885-0778

1. GHISLAINE MAXWELL hereby authorize
Passport Rush, LLC. to submit my passport and collect it when issued.

The following visas are required prior to my departure:

or Dire Date of birth:

Thank you for your prompt attention to this matter.

Originar signature of applicant/minor applicant

For my son/daughter

Prohibited

https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020

EFTA00038789

Scanned Document Collection

Page 4 of 4

# Scanned Document Collection (cont.)

WC U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS OMB APPROVAL NO. 1405-0020 EXPIRATION DATE: 12-31-2013 Please Print Legibly Using Black Ink Only ESTIMATED BURDEN 40 MIN Attention: Read WARNING on page 1 of instructions Please select the document(s) for which you are applying: S. Passport Book The US pass car is ad for national fravel Forn US Passport Card information see page 1 of instructions Both 128 Page Book (andurd) 5ag uuk (Non-Sanda Note: The age opti ato applicant ho have ose sty pe 1. Name MAXWELL End. # Exp. First Middle GHISLAINE NOELLE 2. Date of Birth (mm/dd/yyyy) 3. Sex 4. Place of Birth (City & State if in the US, or City & Country as it is presently known.) Email Primary Contact Phone Number 8. Mailing Address: Line 1. SuBURY, D. Box, or URB Address LiNE 2 CISS Apartment, Company, Suite, Unit, Building, Floor, In Cre Of or Attention if applic Reprof untry Tourer names you have used. (Emples: Birth Name, Malvious Marriage, Legal Name Change. Attach additional B 10. Passport Book and/or Passport Card Information Your name as listed on your most recent passport book and/or passport card звод GHISLAINE NOELLE MAXWELL Most recent passport book sumber Issue date (m 12/04/200 Most recent passport card number Issue date (mm han Information Complete name is different than last passport book or pas ang Ste Kor Disclosure. t you me change CONTINUE TO PAGE 2 YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW I declare under penalty of perjury all of the following: 1) I am a citizen or non-otizen national of the United States and have not, since acquiring U.S. citizenship or nationality. performad any of the acts listed under "Acts or Conditions" on the reverse side of this application (unless explanatory statement is attached); 2) the statements made on the application are true and correct; 3) I have not knowingly and wilfully made false statements or included faise documents in support of this application; 4) the photograph submitted with this applicon is a genuine, current photograph of me; and 5)I have read and understood the warning on page one of the instructions to the application form 4/09/12 Applicants Signature Date FOR ISSUING OFFICE ONLY PPT CR PPT SR Marriage Certificate Date of Marriage/Place-issued Court Order Date Filed/Court From To: Prohibited Other Attached For Issuing Office Only Bk Fe F$110 Cd Fee Postage Other CK DS 82 B 12 2010 1- Page 1 of 2 DS-82 12-2010

# Scanned Document Collection (cont.)

https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020

EFTA00038790