DIA-ANG-80

Code
DIA-ANG-80
Mercy ID
V-02638-02
Encounter Date
11/06/2007
Last
Diaz
First
Angelo
DOB
04/10/1980
County
Dekalb
Street
4206 Rockbridge Rd.
City
Stone mountain
State
GA
Zip
30083-
Home
(404) 297-2896
Cell
(678) 663-8861
Family Status
Single adult
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
Vocational/Technical

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
YES
SOLO
No
Court Mandated
YES
Program Completed
YES
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
YES
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
Angelo Nicolas Diaz 07/28/2000 Mother GA/USA

Former Spouse 1 Information

Last
Morales
First
Nora
DOB
05/03/1972
Telephone
(678) 558-2055
COB
Puerto Rico
Home Owner
No
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
Dekalb County