LOP-SHE-73

Code
LOP-SHE-73
Mercy ID
V-00116-01
Encounter Date
02/02/2000
Last
Lopez
First
Sheny
DOB
01/03/1973
County
Gwinnett
Street
2200 Willow Trail Pkwy B-19
City
Norcross
State
GA
Zip
30093-
Cell
(678) 349-8840
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
same
Telephone
N/A
COB
N/A
Home Owner
No
Driver
No
Home Owner
YES
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
Jacob Candelaria 07/23/2000 Mother GA/USA
Jenifer Caderon 09/09/1993 Mother GA/USA
Julio Candelaria 08/20/2004 Mother GA/USA

Former Spouse 1 Information

Last
Candelaria
First
Julio c
DOB
02/17/1977
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
D. Gomez
Referred By
linea-Juana