Pancho - PER-JOR-94

Code: PER-JOR-94
Mercy ID: V-02994-21
Encounter Date: 01/28/2009
Last: Perez
First: Jorge
DOB: 04/23/1994
County: Cobb
Street: 7311 Elsner Rd.
City: Austell
State: GA

Zip

30168-

Cell

(678) 260-7047

Family Status

Child/Youth

COB

Mexico

Gender

Male Child

Housing

Single Family

Education Level

some high school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria E. Perez	10/09/1977	Mexico
Father	Rogelio Lopea	09/15/1977	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Pebbolbrook H.S.
Grade: 10th.
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: C. Martinez
Data Entry: J. Manzo