LAR-ALE-78

Code
LAR-ALE-78
Mercy ID
V-02690-01
Encounter Date
01/15/2008
Last
Lara
First
Alejandra
DOB
06/16/1978
County
Gwinnett
Street
3292 Windgate Dr.
City
Buford
State
GA
Zip
30519-
Cell
(678) 749-4528
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Doubling Up
Education Level
H.S. equivalency diploma

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
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
Esteban Susa 05/31/1997 Mother GA/USA
Sara Lara 10/23/2003 Mother GA/USA

Former Spouse 1 Information

Last
Susa
First
Eduardo
DOB
07/13/1973
Telephone
N/A
COB
Colombia
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-Juana