Pancho - MAR-KEL-03

Code: MAR-KEL-03
Mercy ID: V-02023-11
Encounter Date: 09/14/2005
Last: Martinez
First: Kelly
DOB: 11/12/2003
County: Dekalb
Street: 0000
City: Chamblee
State: GA

Zip

30341-

Cell

(678) 663-8612

Family Status

Attached youth

COB

Mexico

Gender

Female Child

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Irma Revilla	05/15/1978	Mexico
Father	Victor Martinez	11/08/1972	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: N/A
Grade: N/A
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: Volunteer
Data Entry: R. Gonzalez