AVE-MAR-80

Code
AVE-MAR-80
Mercy ID
V-02057-01
Encounter Date
10/04/2005
Last
Santamaria
First
Martha
DOB
02/16/1980
County
Gwinnett
Street
5910 Hickort Spring Dr
City
Norcross
State
GA
Zip
30071-
Home
(678) 475-7414
Cell
(404) 388-8219
Family Status
Single parent w/children
COB
Ecuador
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
Avecillas
First
Felipe
DOB
06/24/1976
Address
N/A
Telephone
N/A
COB
Ecuador
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
Emely Avecillas 06/13/2004 Mother GA/USA
Estuart Avecillas 10/29/2001 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
R. Gonzalez
Referred By