PER-MAR-90

Code
PER-MAR-90
Mercy ID
V-03231-01
Encounter Date
01/05/2010
Last
Perez
First
Maria brenda
DOB
10/14/1990
County
Polk
Street
1343 Brooks St.
City
Cedartown
State
GA
Zip
30125-
Cell
(678) 347-6342
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education

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
Mayla Juarez 08/03/2009 Mother GA/USA
Nereida Juarez 03/27/2006 Mother GA/USA
Sergio Perez 04/13/2004 Mother GA/USA
Yoselin Juarez 05/28/2007 Mother GA/USA

Former Spouse 1 Information

Last
Juarez
First
Jorge
DOB
03/15/1981
Telephone
N/A
COB
Guatemala
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