e 6L ZJI)Code erinformation 7. Date of Birth (mm/dd/yyyy) ► 8. Country of Birth 9. 10. . titer (if any) Entry Inforentizt0th 11. Dale of Last Batty into the United States (nnliddiTRY) ► 12. Place of Last Entry Into the United States (City and State) LDS *N66LES , CA. Form I-102 10/19/17 N Pa