MEN-MAR-71

Code
MEN-MAR-71
Mercy ID
V-02943-01
Encounter Date
11/04/2008
Last
Mendez
First
Maria
DOB
04/08/1971
County
Fulton
Street
1170 Woodland Ave. NE #13
City
Atlanta
State
GA
Zip
30324-
Home
(404) 417-9940
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Preschool

Spouse Information

Last
Diaz
First
Jesus
DOB
08/06/1976
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
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
Giovani Diaz 01/11/2008 Parents GA/USA
Jesus Mendez 11/07/1991 Mother w/Stepfather GA/USA
Vicki Mendez 12/11/1996 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Mendez
First
Jesus
DOB
09/08/1969
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-Griselda