MON-ISM-72

Code
MON-ISM-72
Mercy ID
V-00977-02
Encounter Date
07/16/2002
Last
Montufar
First
Ismael
DOB
11/22/1972
County
Fulton
Street
4689 Roswell Rd. F-3
City
Atlanta
State
GA
Zip
30342-
Home
(404) 843-0557
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Maldonado
First
Margarita
DOB
06/10/1972
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
YES
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
No
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
Adileni 10/12/1999 Parents GA/USA
Azucena 07/07/1994 Parents GA/USA
Rosa Elizabeth 06/19/1993 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
R. Miranda
Data Entry
K. Aleman
Referred By
Fulton