Pancho - GUZ-BER-96

Code: GUZ-BER-96
Mercy ID: V-01734-12
Encounter Date: 10/27/2004
Last: Guzman
First: Berenice
DOB: 04/02/1996
County: Cobb
Street: 2640 Burrell Court
City: Kennesaw
State: GA

Zip

30144-

Home

(770) 572-1736

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Natividad Guzman	12/14/1976	Mexico
Father	Roberto Rivera	09/11/1976	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: 1st.
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