AYA-MAR-70

Code
AYA-MAR-70
Mercy ID
V-02923-01
Encounter Date
10/21/2008
Last
Ayala
First
Marisol
DOB
07/06/1970
County
Douglass
Street
3685 Glenda St.
City
Lithia
State
GA
Zip
30122-
Cell
(404) 625-4579
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
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
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
Daniel Muñoz 01/14/2000 Mother GA/USA
Luis J. Cabrera 10/10/1991 Deceased GA/USA

Former Spouse 1 Information

Last
Muñoz
First
Tomas
DOB
08/30/1970
Telephone
N/A
COB
N/A
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Griselda