BEN-VIC-65

Code
BEN-VIC-65
Mercy ID
V-01325-02
Encounter Date
08/19/2003
Last
Benitez
First
Victor
DOB
03/29/1965
County
Cobb
Street
5881 S Gordon Rd.
City
Austell
State
GA
Zip
30168-
Home
(770) 739-8033
Cell
(678) 234-8309
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Galvan
First
Gloria
DOB
08/20/1970
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
David Benitez 05/19/1999 Parents GA/USA
Karla Fabiola Benitez 07/01/1990 Parents GA/USA
Victor Marin Benitez 11/17/1992 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
Cobb county