LAN-GRI-63

Code
LAN-GRI-63
Mercy ID
V-01340-01
Encounter Date
09/03/2003
Last
Landeros
First
Griselda
DOB
04/11/1963
County
Gwinnett
Street
5141 Hwy 78 214
City
Stone mountain
State
GA
Zip
30087-
Cell
(678) 598-2125
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
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
Griselda Landeros 03/09/1992 Mother GA/USA
Jaime Landeros Jr. 10/02/1990 Mother GA/USA

Former Spouse 1 Information

Last
Landeros
First
Jaime
DOB
01/29/1962
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

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