MAR-MAR-72

Code
MAR-MAR-72
Mercy ID
V-00026-01
Encounter Date
01/05/2000
Last
Pesina
First
Maria amparo
DOB
03/18/1972
County
Cobb
Street
3014 Estuary Rd.
City
Acworth
State
GA
Zip
30101-
Cell
(205) 570-1922
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Cienfuegos
First
Jose luis
DOB
10/26/1971
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
SOLO
No
Court Mandated
No
Program Completed
No
DFCS Mandated
No
Alcohol & Drug
No
Partner Referred to Tepestri
No
Recidivism/Court
No
New Incident
No
Promesa de Confidencialidad
No
Consentimiento De Participar
No

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

TPO
No
Stay Away Condition
No
Mutual
No
Driver
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Aida Yasmin Martinez 03/23/1992 Mother w/Stepfather GA/USA
Alexandro Martinez 04/07/1994 Mother w/Stepfather GA/USA
Dahlia Martinez 03/02/2001 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Martinez
First
Victor jose
DOB
04/24/1968
Telephone
N/A
COB
Mexico
Home Owner
No

Former Spouse 2 Information

Last
L?????????????????????????????
First
L?????????????????????????????
DOB
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
Y. Garcia
Referred By