AYA-SER-70

Code
AYA-SER-70
Mercy ID
V-01036-02
Encounter Date
11/19/2002
Last
Ayala
First
Sergio
DOB
03/21/1970
County
Fulton
Street
2700 Buford Hwy Apt 27
City
Atlanta
State
GA
Zip
30342-
Home
(678) 886-1945
Family Status
Two parent family w/children
COB
Guatemala
Gender
Male
Housing
Doubling Up

Spouse Information

Last
Ayala
First
Concepcion
DOB
03/25/1962
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
Bladdan Ayala 11/16/1991 Parents GA/USA
Neidy Ayala 08/13/1990 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