KIR-ANA-83

Code
KIR-ANA-83
Mercy ID
V-02912-01
Encounter Date
10/14/2008
Last
Kirby
First
Ana
DOB
01/03/2008
County
Gwinnett
Street
4258 Pleasant Lake Village #-F
City
Duluth
State
GA
Zip
30096-
Cell
(404) 437-9718
Family Status
Single parent w/children
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
High school graduate

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
YES
Consentimiento De Participar
YES

Petitioner

TPO
YES
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
Dereck Kirdy 05/20/2007 Mother GA/USA
Heather Kirdy 04/22/2005 Mother GA/USA
Max Kirdy 07/25/2008 Mother GA/USA

Former Spouse 1 Information

Last
Kirdy
First
Dereck
DOB
12/08/1976
Telephone
N/A
COB
N/A
Home Owner
No
NOTES
2009. No A.R. el phone no esta en servicio.

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-Griselda