WE TELEPHONE NUMBER EVENING TELEPHONE NUMBER A LUPAGER NUMBER so: (Ms, F ItACEIETHrriCoexrlN w 0 A - Aslan.IPacific Islander II I - American Indlan/Alaslcan Native D B - Black, Non-Hispanic 0 H - Hispanic 0 W - White, Non-Hispanic 0 M Multiracial DATE CC BIRTH EnmiddiWyy) PLACE OF BIRTH (cfty, state, stone