SAM-LIL-76

Code
SAM-LIL-76
Mercy ID
V-00464-01
Encounter Date
12/26/2007
Last
Mejia
First
Liliana
DOB
03/14/1976
County
Fulton
Street
4825 Northbridge Dr.
City
Alpharetta
State
GA
Zip
30022-
Home
(770) 619-3272
Other
(678) 558-4709
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Mejia
First
Wilfredo
DOB
12/09/1969
Address
N/A
Telephone
N/A
COB
Honduras
Home Owner
YES
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
juan david baltazar 11/03/1992 Mother w/Stepfather GA/USA
Tifany Alison Mejia 11/19/2002 Parents GA/USA
Willy Joel Mejia 09/21/2006 Parents GA/USA

Former Spouse 1 Information

Last
Reyes
First
Baltazar
DOB
10/05/1970
Telephone
N/A
COB
N/A
Home Owner
No
NOTES
***2009. NOANNUAL RETURN***

Media Authoritation

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