ROS-MAR-71

Code
ROS-MAR-71
Mercy ID
V-02600-01
Encounter Date
10/03/2007
Last
Rosales
First
Martina
DOB
02/17/1971
County
Gwinnett
Street
3983 Johns St.
City
Lilburn
State
GA
Zip
30047-
Cell
(678) 497-5684
Other
(678) 698-7474
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Bahena
First
Miguel
DOB
N/A
Address
N/A
Telephone
N/A
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
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
Brandon Sandria 07/05/1995 Father GA/USA
Daniel Sandria 05/22/1992 Father GA/USA
Natalia Sandria 11/14/2001 Mother GA/USA

Former Spouse 1 Information

Last
Sandria
First
Eleazar
DOB
02/01/1973
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