LAN-CAR-61

Code
LAN-CAR-61
Mercy ID
V-03049-01
Encounter Date
04/03/2009
Last
Landa
First
Carmen
DOB
07/12/1961
County
Gwinnett
Street
2263 Stanley Road Lt. A-7
City
Dacula
State
GA
Zip
30019-
Cell
(770) 895-9019
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Doubling Up
Education Level
Some College

Spouse Information

Last
Vargas
First
Benigno
DOB
09/20/1964
Address
N/A
Telephone
N/A
COB
Perú
Home Owner
YES
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
Benjamin Vargas 04/13/2004 Mother GA/USA
Laura Vargas 01/11/1995 Mother GA/USA
Mateo Vargas 07/31/2001 Mother GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By
Albergue Gwinnett