CAS-ANG-74

Code
CAS-ANG-74
Mercy ID
V-03411-01
Encounter Date
08/30/2010
Last
Casimiro
First
Angelica
DOB
03/01/1974
County
Dekalb
Street
4203 Buford Hwy NE Apt. B-6
City
Atlanta
State
GA
Zip
30345-
Cell
(404) 553-3590
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

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
Gael Tzintzun 07/31/2010 Mother GA/USA
Keylee Tzintzon 03/17/2001 Mother GA/USA
Saralee Tzintzan 05/04/2007 Mother GA/USA

Former Spouse 1 Information

Last
Tzintzun
First
Benjamin
DOB
05/23/1981
Telephone
N/A
COB
Mexico
Home Owner
YES
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
YES
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
linea-Juana