Pancho - REY-JAV-97

Code: REY-JAV-97
Mercy ID: V-01893-21
Encounter Date: 10/26/2005
Last: Reyes
First: Javier
DOB: 09/05/1997
County: Gwinnett
Street: 702 Gwinnett Square Circle
City: Duluth
State: GA

Zip

30096-

Home

(770) 209-6658

Cell

(404) 319-5698

Family Status

Attached youth

COB

Mexico

Gender

Male Child

Housing

Not Homeless

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Marisol Zapata	07/13/1979	Mexico
Father	Jose Reyes	04/05/1969	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Charols Brand Chestuy Elem.
Grade: 2nd.
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: R. Gonzalez