CHA-LET-80

Code
CHA-LET-80
Mercy ID
V-01459-01
Encounter Date
01/05/2004
Last
Chavez
First
Leticia
DOB
01/18/1980
County
Dekalb
Street
4713 Bufford Hwy Apt D
City
Chamblee
State
GA
Zip
30341-
Home
(770) 451-0117
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Melendes
First
Jose
DOB
07/21/1976
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
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
Erick Fabian Melendez 12/21/1996 Parents GA/USA
Jose Melendez 03/22/2003 Parents GA/USA
Karina Melendez 03/31/1999 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
x3737 Damaryz 12/30/03