Pancho - MAR-JAZ-01

Code: MAR-JAZ-01
Mercy ID: V-01886-12
Encounter Date: 05/16/2005
Last: Martel
First: Jazlyn
DOB: 09/25/2001
County: Gwinnett
Street: 4498 Buford Hwy #208
City: Norcross
State: GA

Zip

30071-

Home

(678) 755-8251

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Lisbeth Diaz	12/30/1972	Guatemala
Father	Jesus Eloy Martel	11/14/1976	Mexico
Step Parent	N/A	N/A	1

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Baker Lake
Grade: Kinder
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