Pancho - RIV-DAV-04

Code: RIV-DAV-04
Mercy ID: V-02625-21
Encounter Date: 11/14/2007
Last: Rivera
First: David
DOB: 09/21/2004
County: Fayette
Street: 124 West Montway
City: Tirone
State: GA

Zip

30290-

Cell

(678) 548-6906

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	Monica Burgos	02/02/1976	Puerto Rico
Father	Hector Rivero	01/31/1975	Puerto Rico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: Day cara realkids
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: Y. Garcia
Data Entry: J. Manzo