BRU-KEL-79

Code
BRU-KEL-79
Mercy ID
V-01206-02
Encounter Date
03/08/2011
Last
Bruno
First
Kelvin
DOB
09/01/1979
County
Dekalb
Street
4620 Peachtree Place parkway D
City
Doraville
State
GA
Zip
30360-
Cell
(404) 749-6159
Family Status
Single adult
COB
Puerto Rico
Gender
Male
Housing
Doubling Up
Education Level
High school graduate

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
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
Eunen Cordova 08/26/2000 Mother GA/USA
Guadalupe Sanchez 02/10/2006 Mother GA/USA
Jade Guillen 10/22/2005 Aunt Sandra/Atlanta
Jose Cordova N/A Mother GA/USA

Former Spouse 1 Information

Last
Guillen
First
Sandra
DOB
07/20/1977
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. Manzo
Data Entry
J. Manzo
Referred By
linea-Lucero Solis