Pancho - MAN-LUI-04

Code: MAN-LUI-04
Mercy ID: V-03393-21
Encounter Date: 09/01/2010
Last: Mancilla
First: Luis
DOB: 04/03/2004
County: Gwinnett
Street: 2272 Newbury Rd.
City: Norcross
State: GA

Zip

30071-

Cell

(770) 255-8503

Family Status

Child/Youth

COB

USA

Gender

Male Child

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Ana Moreno	03/19/1983	Mexico
Father	Luis Mancilla	03/02/1979	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: River Eves
Grade: 1st.
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: J. Manzo