Title 18

XTREME STUDIOS MEDIA
501 S LOS ANGELES ST UNIT 402 LOS ANGELES CA 90013 (669) 300-0029 WWW.STUDIO69.ANGENCY
CHARITY NETWORK
Full Name

First NameLast Name
NASHVILLE MCKNIGHT CEO AND PRESIDENT-FOUNDER

18 U.S.C. § 2257 Records Keeping for Models

(print full legal name) ("Model"), understand that all the information required by this document is required to comply with United States federal law and any false statement or misrepresentation may constitute a crime under United States law.

B. Two forms of identification, including at least one government-issued photo identification, are required. Describe each, including the number. Clear photocopies of each identification must be attached and the photocopies must be signed in BLUE ink by the Model.

(1) First form of identification:

(2) Second form of identification:
IDType
iD #
Exp Date

MonthDayYear
Date
2nd IDType
2 iD #
2nd Exp Date

MonthDayYear
Date
Age
Date of Birth

MonthDayYear
Date
C. As of today's date, I use or have also used, or I am known or have been known by, the following names, stage names, aliases,

nicknames and married and/or maiden names:
1
2
3
4
If more than 4 please attach a separate sheet, signed by the Model including the additional names.

(full legal name), pursuant to 28 U.S.C. $1746 and the penalties of perjury, under the laws of the United States, swear that the above is true and correct and that the identifications which I have provided, copies of which are attached and signed by me, were lawfully obtained by me and have not been forged or altered.
Todays Date

MonthDayYear
Date
Signature

Clear
Model's Signature (using full legal name)

According to 28 U.S.C. $1746 and the penalties of perjury under the laws of the United States, I swear that I have personally examined the Model's identifications containing the date of birth set forth above, that I have personally questioned the Model regarding the answers given in this document, and that I have observed that Model execute this document and sign the attached copy of the identifications. In addition, I swear that the date set forth below is when production involving this Model occurred. Date or years of Production: July 1, 2019 to June 2025 Location of Production: Inland Empire California, Las Vegas, Phoenix AZ, Los Angeles CA

FILE: Title 18A LAST UPDATE:0 /25/234
Should be Empty:

XTREME STUDIOS MEDIA

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