MAY-BLA-71

Code
MAY-BLA-71
Mercy ID
V-02413-01
Encounter Date
02/20/2007
Last
Maya
First
Blanca
DOB
06/19/1971
County
Fulton
Street
6006 Gardnen River Dr.
City
Alpharetta
State
GA
Zip
30004-
Cell
(404) 392-2794
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Some College

Spouse Information

Last
N/A
First
N/A
DOB
09/12/1970
Address
N/A
Telephone
(678) 549-6461
COB
Mexico
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
Benjamin Sandoval 07/26/2003 Mother GA/USA
Luis Sandoval 10/19/2000 Mother GA/USA

Former Spouse 1 Information

Last
Sandoval
First
Jose luis
DOB
09/12/1970
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana