panic O M-Multiacial (1) DATE Cf 011114 itAINDONYYY) (12) PLACE CC MTN rag so* county) WEST PALM BEACH FL US FLORIDA (13) RESIDENT STARS 3 CI O. Foreign Exchange Student O 1. Out-of-county Resident O 2. Out-of-state Resident O 3. In-county Resident (14) USA ENTRY DATE (01/DantYYY) (15) FEDERAL IMPACT SURVEY YES