BOT-BLA-72

Code
BOT-BLA-72
Mercy ID
V-00959-01
Encounter Date
09/22/1999
Last
Botello
First
Blanca
DOB
09/20/1972
County
Not given
Street
347 River Brook Trail
City
Riverdale
State
GA
Zip
30274-
Home
(770) 996-7343
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Botello
First
Ernesto
DOB
12/24/1972
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
YES
Consentimiento De Participar
YES

Petitioner

TPO
No
Stay Away Condition
No
Mutual
No

Defendant

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

Children

NAME DOB LIVING WITH STATE/COUNTRY
Sally Lopez 09/09/1990 Mother GA/USA
Shadee Marmolejo 07/24/1999 Parents GA/USA
Yardley Lopez 01/25/1993 Mother GA/USA

Former Spouse 1 Information

Last
Vasquez
First
Francisco
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Clayton Court