ZAV-MAR-90

Code
ZAV-MAR-90
Mercy ID
V-03437-01
Encounter Date
10/12/2010
Last
Zavala
First
Maribel
DOB
04/03/1990
County
Dekalb
Street
3695 Buford Hwy NE
City
Atlanta
State
GA
Zip
30329-
Cell
(770) 274-8962
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
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
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
Cristian Sandoval 01/17/2010 Mother GA/USA
Lina Ignacio 01/16/2006 Mother GA/USA

Former Spouse 1 Information

Last
Sandoval
First
Cristian
DOB
02/04/1972
Telephone
N/A
COB
Mexico
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
J. Manzo
Referred By