GOM-GWE-79

Code
GOM-GWE-79
Mercy ID
V-03227-01
Encounter Date
12/28/2009
Last
Gomez
First
Gwendolyne
DOB
11/24/1979
County
Dekalb
Street
2377 Woodside St.
City
Atlanta
State
GA
Zip
30341-
Cell
(404) 552-1661
Family Status
Single parent w/children
COB
Mexico
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
YES
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
YES
Consentimiento De Participar
YES

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
Dayanara Perez 04/14/2006 Mother GA/USA

Former Spouse 1 Information

Last
Perez
First
Juan angel
DOB
04/24/1979
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Jacqueline