Pancho - LOP-KAR-96

Code: LOP-KAR-96
Mercy ID: V-01643-12
Encounter Date: 07/28/2004
Last: Lopez
First: Karla
DOB: 06/19/1996
County: Gwinnett
Street: 5615 Hammond Dr.
City: Norcross
State: GA

Zip

30071-

Home

(404) 643-2852

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Imelda Mata	06/29/1972	Mexico
Father	Carlos Alberto	03/13/1972	Mexico
Step Parent	Juan Carlos Ramos	03/30/1982	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother w/Stepfather
Name of School: Norcross Elementary School
Grade: 3rd.
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: Y. Garcia
Data Entry: K. Aleman