PAE-MAR-83

Code
PAE-MAR-83
Mercy ID
V-03015-01
Encounter Date
02/23/2009
Last
Paez
First
Maria de jesus
DOB
12/05/1983
County
Fulton
Street
4372 Edineurgh Way
City
Conley
State
GA
Zip
30288-
Cell
(404) 356-9287
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Single Family
Education Level
H.S. equivalency diploma

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
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
Derek Zamora 01/08/2008 Parents GA/USA

Former Spouse 1 Information

Last
Zamora
First
Javier
DOB
N/A
Telephone
N/A
COB
N/A
Home Owner
YES
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