JET-PAS-76

Code
JET-PAS-76
Mercy ID
V-02218-01
Encounter Date
04/06/2006
Last
Jeter
First
Pasquiel
DOB
07/16/1976
County
Gwinnett
Street
6369 Brandywine Tr
City
Norcross
State
GA
Zip
30092-
Home
(678) 966-9693
Cell
(404) 255-3782
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Lozada
First
Esteban
DOB
12/19/1978
Address
N/A
Telephone
(678) 598-4181
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
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
Adriana Jeter 12/15/1990 Mother w/Stepfather GA/USA
Ariel Jeter 07/14/1993 Mother w/Stepfather GA/USA
David Jeter 03/02/1998 Mother w/Stepfather GA/USA
Jovani Jeter 03/25/1999 Mother w/Stepfather GA/USA
Ruben Jeter 01/24/1995 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Valenciano
First
Ruben
DOB
N/A
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
G. Landeros
Data Entry
R. Gonzalez
Referred By
Felipe