IGL-JAC-69

Code
IGL-JAC-69
Mercy ID
V-03060-01
Encounter Date
04/29/2009
Last
Iglesias
First
Jacqueline
DOB
02/02/1969
County
Gwinnett
Street
9999 no la sabe
City
Buford
State
GA
Zip
30519-
Other
(678) 949-8802
Family Status
Single parent w/children
COB
Colombia
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
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
Isabel Garcia 02/17/2006 Father GA/USA
Nicolas Garcia 10/27/1991 Father GA/USA
Sebastian Garcia 09/30/1988 Mother GA/USA

Former Spouse 1 Information

Last
Garcia
First
Wolmer
DOB
06/16/1967
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-Juana