VEG-ISR-60

Code
VEG-ISR-60
Mercy ID
V-02858-01
Encounter Date
07/23/2008
Last
Vega
First
Israela
DOB
03/09/1960
County
Wayne
Street
255 Pine Street Road
City
Jesup
State
GA
Zip
31545-
Cell
(319) 528-1630
Family Status
Two parent family w/children
COB
Cuba
Gender
Female
Housing
Single Family
Education Level
High school graduate

Spouse Information

Last
Gomez
First
Francisco
DOB
03/08/1975
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
Raymundo Gomez 10/10/1998 Parents GA/USA
Rosa Altamirano 11/18/1992 Mother w/Stepfather GA/USA
Rosario Gomez 09/01/2000 Parents GA/USA

Former Spouse 1 Information

Last
Altamirano
First
Emanuel
DOB
12/20/1958
Telephone
N/A
COB
N/A
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