Pancho - TAV-MAR-96

Code: TAV-MAR-96
Mercy ID: V-02327-11
Encounter Date: 09/13/2006
Last: Tavera
First: Maria
DOB: 07/18/1996
County: Dekalb
Street: 751 North Indian Creek Dr. # 244
City: Clarkston
State: GA

Zip

30021-

Home

(404) 296-9334

Family Status

Child/Youth

COB

USA

Gender

Female Child

Housing

Single Family

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Maria Jimenez	04/07/1972	Mexico
Father	Juan Tavera	06/24/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Mother
Name of School: Indian Creek Elem
Grade: 5th.
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