SEV-GEO-79

Code
SEV-GEO-79
Mercy ID
V-03481-01
Encounter Date
12/07/2010
Last
Sevilla
First
Geovania
DOB
02/11/1979
County
Other
Street
3821 Winsleld Drivw
City
Charlotte
State
GA
Zip
28205-
Cell
(704) 777-6919
Family Status
Single parent w/children
COB
Nicaragua
Gender
Female
Housing
Doubling Up
Education Level
some high 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
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
Jade D. Sevilla 10/10/2010 Mother GA/USA
Roxelin Garmendia 09/01/1997 Grandmother Nicaragua-Materna

Former Spouse 1 Information

Last
Lucero
First
Jose i
DOB
10/29/1978
Telephone
N/A
COB
El Salvador
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
linea-Juana