MEN-ANA-70

Code
MEN-ANA-70
Mercy ID
V-01201-01
Encounter Date
04/08/2003
Last
Mendoza
First
Ana lilia
DOB
12/18/1970
County
Cobb
Street
6412 Piney Circle
City
Mableton
State
GA
Zip
30126-
Home
(678) 945-1891
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Perez
First
Ruben
DOB
04/11/1968
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
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
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Bryant de U Peralta Mendoza 03/23/1992 Brother Mexico
Cristian O Peralta Mendoza 08/22/1989 Brother Mexico
Stephany M. Peralta Mendoza 08/20/1990 Brother Mexico
NOTES

Media Authoritation

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