TRE-BRE-82

Code
TRE-BRE-82
Mercy ID
V-03416-01
Encounter Date
09/01/2010
Last
Trejo
First
Brenda
DOB
01/17/1982
County
Fulton
Street
822 Parkridge Lane # 6
City
Roswell
State
GA
Zip
30076-
Cell
(404) 784-9062
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Rubalcava
First
Jose
DOB
12/09/1984
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
Janice Rubalcava 05/03/2010 Parents GA/USA
Jessy Gomez 01/10/2003 Mother w/Stepfather GA/USA
Justin Gomez 05/28/2005 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Gomez
First
Jesus
DOB
N/A
Telephone
N/A
COB
Mexico
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
linea-Juana