GAR-SAM-77

Code
GAR-SAM-77
Mercy ID
V-03448-01
Encounter Date
10/26/2010
Last
Garcia
First
Samira
DOB
12/15/1977
County
Fulton
Street
125 northwood Dr.
City
Sandy springs
State
GA
Zip
30342-
Cell
(404) 399-7978
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Dorantes
First
Antonio
DOB
12/11/1977
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
Keven Dorantes 10/16/1999 Grandmother Mexico-Materna
Michelle Dorantes 11/06/1987 Grandmother Mexico-Paterna
Yoselin Dorantes 01/13/2007 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
Jacqueline