GON-GUA-74

Code
GON-GUA-74
Mercy ID
V-02812-01
Encounter Date
06/11/2008
Last
Gonzalez
First
Guadalupe
DOB
12/12/1974
County
Fulton
Street
513 Highland Park
City
Sandy spring
State
GA
Zip
30350-
Cell
(678) 683-0340
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Wulff
First
Ryan
DOB
03/12/1976
Address
N/A
Telephone
N/A
COB
USA
Home Owner
YES
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
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
Cinthia Casarubias 09/01/1994 Mother w/Stepfather GA/USA
Iban Casarubias 03/05/1993 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Casarubias
First
Cutberto
DOB
03/31/1973
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
Amiga de Blanca/Linea-Griselda