JIM-MAR-72

Code
JIM-MAR-72
Mercy ID
V-02327-01
Encounter Date
12/09/2006
Last
Jimenez
First
Maria araceli
DOB
07/04/1972
County
Dekalb
Street
751 Noth Indian Creek Dr. Apt. 244
City
Clarkston
State
GA
Zip
30021-
Home
(404) 296-8334
Cell
(678) 933-2579
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
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
Araceli V. Tavera 10/10/1997 Mother GA/USA
Maria G. Tavera 07/18/1996 Mother GA/USA

Former Spouse 1 Information

Last
Tavera
First
Juan
DOB
06/24/1973
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea