Pancho - MAR-ANG-03

Code: MAR-ANG-03
Mercy ID: V-01918-21
Encounter Date: 07/06/2005
Last: Martinez
First: Angel
DOB: 08/08/2003
County: Fulton
Street: 811 Park Ridge Lane Apt. D
City: Roswell
State: GA

Zip

30076-

Cell

(678) 851-6164

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Yanin Ceja	11/26/1982	Mexico
Father	Eduardo Martinez	05/21/1977	Mexico
Step Parent	Saul Garcia	10/12/1989	Mexico

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Mimosa Elem.
Grade: 2nd.
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: Y. Garcia
Data Entry: K. Aleman