GAR-MAR-80

Code
GAR-MAR-80
Mercy ID
V-02627-01
Encounter Date
10/11/2007
Last
Garcia
First
Maria del carmen
DOB
07/16/1980
County
Gwinnett
Street
1635 Pirkle Rd. # 1304
City
Norcross
State
GA
Zip
30093-
Home
(770) 825-0969
Cell
(678) 886-7471
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
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
Joedylen Fernandez 09/03/2004 Mother GA/USA
Jonbent Fernandez 05/28/2005 Mother GA/USA

Former Spouse 1 Information

Last
Fernandez
First
Martin
DOB
01/30/1966
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
G. Landeros
Data Entry
J. Manzo
Referred By
Linea-Griselda