BUR-MON-76

Code
BUR-MON-76
Mercy ID
V-02625-01
Encounter Date
10/22/2007
Last
Burgos
First
Monica
DOB
02/02/1976
County
Fayette
Street
124 WestMont Way
City
Tyreno
State
GA
Zip
30290-
Cell
(678) 548-6906
Family Status
Two parent family w/children
COB
Puerto Rico
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
Rivera
First
Hector
DOB
01/31/1975
Address
N/A
Telephone
N/A
COB
Puerto Rico
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
YES
Consentimiento De Participar
YES

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
David Ariel Rivera 09/21/2004 Parents GA/USA
Leira Rivera 03/09/2006 Parents GA/USA
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Padre Hernan