BAS-IME-75

Code
BAS-IME-75
Mercy ID
V-01640-01
Encounter Date
06/16/2004
Last
Bastida
First
Imelda leticia
DOB
05/13/1975
County
Fulton
Street
6940 Roswell Rd. Apt 2A
City
Atlanta
State
GA
Zip
30328-
Home
(770) 393-8521
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Garcia
First
Manuel
DOB
05/30/1979
Address
N/A
Telephone
(404) 969-7288
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
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
Armando Garcia 01/24/2001 Parents GA/USA
Emmanuel Garcia 01/05/2000 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
Rafael