Pancho - HER-BEN-91

Code: HER-BEN-91
Mercy ID: V-01392-21
Encounter Date: 10/29/2003
Last: Herrera
First: Benjamin
DOB: 07/06/1991
County: Dekalb
Street: 1843 A Skyland Terrace
City: Atlanta
State: GA

Zip

30319-

Home

(404) 638-6899

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Maria Villanueva	05/06/1971	Mexico
Father	Benjamin Herrera	09/18/1977	Mexico
Step Parent	Jose Mata	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Kipp Path Academy
Grade: 6th.
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: K. Aleman
Data Entry: K. Aleman