LAY-MAR-78

Code
LAY-MAR-78
Mercy ID
V-02251-01
Encounter Date
05/17/2006
Last
Laynez
First
Maritza
DOB
08/18/1978
County
Dekalb
Street
102 Winter Creek
City
Doraville
State
GA
Zip
30360-
Home
(678) 615-3816
Other
(678) 891-8837
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Puac
First
Luis roberto
DOB
06/21/1970
Address
N/A
Telephone
(678) 615-3816
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
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
Luis Alexis Puac Jr 01/19/2004 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
Fabiola Gomez