PER-GLA-73

Code
PER-GLA-73
Mercy ID
V-01502-01
Encounter Date
02/25/2004
Last
Perez
First
Glafira
DOB
11/14/1973
County
Clayton
Street
7677 Tara Blvd.
City
Jonesboro
State
GA
Zip
30236-
Home
(770) 603-2086
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Diaz
First
Porfirio
DOB
N/A
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
YES
As A Child
No
Relative
No
Stranger
No
As An Adult
No
Partner
No
Relative
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Diana 04/11/1996 Parents GA/USA
Francisco Diaz 09/15/1993 Parents GA/USA
Jesus Diaz 09/27/2000 Parents GA/USA
Leonardo Diaz 08/11/1992 Parents GA/USA
Mauricio Diaz 12/08/1990 Parents GA/USA
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
x1375 Damaryz