GOD-BLA-71

Code
GOD-BLA-71
Mercy ID
V-01896-01
Encounter Date
04/27/2005
Last
Godinez
First
Blanca
DOB
02/14/1971
County
Dekalb
Street
2235 Plaster Rd. Apt 1
City
Atlanta
State
GA
Zip
30345-
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Mejia
First
Jeremias
DOB
07/24/1974
Address
N/A
Telephone
N/A
COB
Guatemala
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
Diana Alexis Mejia 03/10/2003 Parents GA/USA
Felix Daniel Mejia 11/14/2004 Parents GA/USA
Selene Godines 12/26/1998 Mother w/Stepfather 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
Walk-in