PEÑ-JOH-79

Code
PEÑ-JOH-79
Mercy ID
V-02462-02
Encounter Date
06/12/2007
Last
Peña
First
Johnny
DOB
12/23/1979
County
Fulton
Street
325 Crossing Way
City
Roswell
State
GA
Zip
30076-
Cell
(678) 531-4851
Family Status
Single adult
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Bazan
First
Romeli
DOB
11/21/1982
Address
N/A
Telephone
(678) 608-8702
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
No
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
Johnny David Peña 09/20/2005 Mother GA/USA
NOTES

Media Authoritation

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