MON-ELV-58

Code
MON-ELV-58
Mercy ID
V-03327-01
Encounter Date
05/17/2010
Last
Montañez
First
Elva
DOB
11/12/1958
County
Gwinnett
Street
2738 The falls
City
Duluth
State
GA
Zip
30096-
Cell
(404) 838-0976
Family Status
Single adult
COB
Perú
Gender
Female
Housing
Single Family
Education Level
College Degree

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
No
Consentimiento De Participar
YES

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
Joao Arrunatecui 05/03/1991 Mother GA/USA

Former Spouse 1 Information

Last
Montañez
First
Raul
DOB
04/06/1945
Telephone
N/A
COB
Perú
Home Owner
YES
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
Walk in