VAL-PAJ-75

Code
VAL-PAJ-75
Mercy ID
V-01503-01
Encounter Date
02/27/2004
Last
Valente
First
Pagita
DOB
10/09/1975
County
Rockdale
Street
1019 Green Valley Dr. NW
City
Conyers
State
GA
Zip
30012-
Cell
(404) 593-4206
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical

Spouse Information

Last
N/A
First
N/A
Middle
H.
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
No
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Angel A. Ayala 08/16/2005 Mother GA/USA
David V. Ayala 07/17/2006 Mother GA/USA
Fatima Valente 03/10/2009 Mother GA/USA
Jose Homero Ayala 07/09/2003 Mother GA/USA
Juan Manuel Valente 12/02/2000 Mother GA/USA

Former Spouse 1 Information

Last
Ayala
First
Jose
DOB
10/03/1982
Telephone
N/A
COB
N/A
Home Owner
No
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
Refugio de Conyers