Pancho - GOM-JUA-97

Code: GOM-JUA-97
Mercy ID: V-01585-23
Encounter Date: 09/22/2010
Last: Gomez
First: Daniel
DOB: 12/13/1997
County: Gwinnett
Street: 235 Mountain Dr.
City: Stone mountain
State: GA

Zip

30087-

Cell

(678) 849-7053

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Reyna Hernandez	07/15/1966	Mexico
Father	N/A	N/A	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Shiloh Mdl. Schl
Grade: 7th.
Who Can't Pickup the Child
Authoritation Parent: YES
Authoritation Child: No
DOY PERMISO: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: Volunteer
Data Entry: J. Manzo