JUA-GRA-74

Code
JUA-GRA-74
Mercy ID
V-02666-01
Encounter Date
12/04/2007
Last
Juarez
First
Graciela
DOB
04/24/1974
County
Clayton
Street
812 Doewood High circle
City
Jonesboro
State
GA
Zip
30238-
Home
(404) 372-3489
Cell
(770) 912-6373
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
H.S. equivalency diploma

Spouse Information

Last
Guerrero
First
Anastacio
DOB
06/14/1984
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
YES
Consentimiento De Participar
YES

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
Bryant Juarez 03/20/2000 Mother GA/USA
Cynthia Juarez 07/29/1994 Mother GA/USA
Magali Juarez 02/25/1996 Mother GA/USA
Margarita Juarez 11/23/2001 Mother GA/USA
Maribel Juarez 11/23/2001 Mother GA/USA

Former Spouse 1 Information

Last
Mendoza
First
Lazaro
DOB
02/22/1975
Telephone
N/A
COB
Guatemala
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