MAR-KEI-83

Code
MAR-KEI-83
Mercy ID
V-02740-01
Encounter Date
03/26/2008
Last
Martinez
First
Queira
DOB
01/01/1982
County
Gwinnett
Street
3245 Samrise Village Lane
City
Norcross
State
GA
Zip
30093-
Cell
(404) 963-3082
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Salinas
First
Francisco
DOB
03/31/1981
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
Charon Ponce 09/11/2003 Mother GA/USA
Keila Ponce 09/17/2001 Mother Honduras
Laura Ponce 03/19/1999 Mother Honduras

Former Spouse 1 Information

Last
Ponce
First
Fausto
DOB
08/19/1979
Telephone
N/A
COB
Honduras
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
linea/Amiga