PET-BEN-76

Code
PET-BEN-76
Mercy ID
V-00593-02
Encounter Date
07/10/2001
Last
Lopez
First
Benjamin
DOB
10/10/1976
County
Fulton
Street
5320 Roswell Rd. Apt F3
City
Atlanta
State
GA
Zip
30342-
Home
(404) 784-6428
Cell
(404) 784-6428
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Other
Education Level
Child, not in school

Spouse Information

Last
Marcial lorenzo
First
Maria
DOB
01/24/1981
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
No
Program Completed
YES
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
Benjamin Petatan 07/21/1998 Parents GA/USA
Bryan Petatan 10/28/2001 Parents GA/USA
NOTES
aka Benjamin Petatan

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
F. Perez
Data Entry
K. Aleman
Referred By
Fulton County