Pancho - PEÑ-HEA-07

Code: PEÑ-HEA-07
Mercy ID: V-02617-11
Encounter Date: 10/10/2007
Last: Peñaloza
First: Heaven
DOB: 02/28/2007
County: Cobb
Street: 584 Conneticut Rd.
City: Marietta
State: GA

Zip

99999-

Cell

(678) 768-4720

Family Status

Attached youth

COB

USA

Gender

Female Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Areli Cortes	03/23/1980	Mexico
Father	Luis Peñaloza	11/09/1977	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: C. Martinez
Data Entry: J. Manzo