MAI-MAR-75

Code
MAI-MAR-75
Mercy ID
V-03216-01
Encounter Date
12/03/2009
Last
Martinez
First
Maria de jesus
DOB
03/20/1975
County
Gwinnett
Street
4155 Oaklan cr
City
Duluth
State
GA
Zip
30096-
Cell
(678) 507-5750
Other
(678) 522-0132
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
College Degree

Spouse Information

Last
Petatan
First
Miguel angel
DOB
12/26/1971
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
Edwin Petatan 10/26/2007 Parents GA/USA
Jairo E. Martinez 11/14/1998 Mother w/Stepfather GA/USA
Randy G. Petatan 01/25/2006 Parents 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
Llamo al cell-Adriana Llano