PER-REY-76

Code
PER-REY-76
Mercy ID
V-03342-01
Encounter Date
06/15/2010
Last
Perez
First
Reyna
DOB
04/28/1976
County
Gwinnett
Street
4515 Brandon Dr. SW
City
Lilburn
State
GA
Zip
30047-
Home
(770) 985-2583
Cell
(404) 867-0293
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Martinez
First
Cesar
DOB
08/04/1973
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
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
Ana Karen Martinez 01/26/2005 Parents GA/USA
Bryant Martinez 10/02/1996 Father w/Stepmother GA/USA
David A. Martinez 06/17/1998 Parents GA/USA
Katie S. Martinez 08/18/2003 Parents GA/USA
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
Entrevista-Jacqueline