BEN-LIL-80

Code
BEN-LIL-80
Mercy ID
V-03533-01
Encounter Date
03/03/2011
Last
Benitez
First
Liliana
DOB
12/09/1980
County
Dekalb
Street
1028 Brook View Ave.
City
Doraville
State
GA
Zip
30340-
Cell
(770) 374-6996
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
Olmos
First
Jose
DOB
02/22/1987
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
Bennacir Segura 01/11/2001 Mother w/Stepfather GA/USA
Edwin Segura 01/07/2004 Mother w/Stepfather GA/USA
Jamileth Segura 10/05/2002 Mother w/Stepfather GA/USA
Jesus E. Segura 01/07/2004 Parents GA/USA
Naileth Segura 06/30/1998 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Segura
First
Alfredo
DOB
01/12/1931
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
Linea de Informacion