MON-ISA-74

Code
MON-ISA-74
Mercy ID
V-02623-01
Encounter Date
10/16/2007
Last
Montes
First
Isabel
DOB
12/09/1974
County
Dekalb
Street
6800 Peachtree Ind. Blv. C-10
City
Doraville
State
GA
Zip
30360-
Cell
(678) 851-3568
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Ortiz
First
Jose
DOB
02/02/2011
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
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
Andres Jauregui 11/17/1993 Grandmother Mexico
Jessica B. Jauregui 06/27/1991 Grandmother Mexico

Former Spouse 1 Information

Last
Avelino
First
Daniel
DOB
03/24/1978
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES
Abuela Materna.*****2008, NO SE CONTACTO, NO A.R.*****

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
Tapestri-Vanisa