-American Indian/Alaskan Native O B:BlicK Non-Hispanic O H-Hispanic O A-Asian/Pacific Islander O W-White, Non-Hispanic O M-Multiracial on DATE OF ERRTH (MLIaflnYYY) (12) PLACE OF WITH (aty. 5104 comity) WEST PALM BEACH FL US FLORIDA (13) RESIDENT STATUS 3 O 0. Foreign Exchange Student O 1.