MOR-LUZ-63

Code
MOR-LUZ-63
Mercy ID
V-02342-01
Encounter Date
10/11/2006
Last
Moreno
First
Luz
DOB
02/28/1963
County
Gwinnett
Street
4365 Brook Ridge Dr.
City
Loganville
State
GA
Zip
30052-
Cell
(770) 220-2829
Work
(770) 220-2829
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Balderson
First
Timothy
DOB
03/22/1967
Address
N/A
Telephone
N/A
COB
USA
Home Owner
YES
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
Johann S. Suaza 12/05/1990 Mother w/Stepfather GA/USA
Timothy Balderson 07/18/2003 Parents GA/USA
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