BUR-GLO-49

Code
BUR-GLO-49
Mercy ID
V-00006-01
Encounter Date
01/05/2000
Last
Burgos
First
Gloria
DOB
10/13/1949
County
Gwinnett
Street
2828 porter dr
City
Lawrenceville
State
GA
Zip
30044-
Home
(770) 935-8464
Family Status
Adult coupie-no children
COB
Colombia
Gender
Female
Housing
Not Homeless
Education Level
High school graduate

Spouse Information

Last
Burgos
First
Pedro
DOB
N/A
Address
N/A
Telephone
N/A
COB
Puerto Rico
Home Owner
No
Driver
No
Home Owner
YES
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
joseph l tavarez 07/27/1970 Adulto/Soltero GA/USA
NOTES

Media Authoritation

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