BUR-MAR-66

Code
BUR-MAR-66
Mercy ID
V-01227-01
Encounter Date
05/14/2003
Last
Burciaga
First
Maria guadalupe
DOB
05/06/1966
County
Gwinnett
Street
6204 Josephine Rd.
City
Doraville
State
GA
Zip
30340-
Home
(770) 441-9273
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Burciaga
First
Salvador
DOB
05/23/1971
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
YES
Consentimiento De Participar
YES

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
Brian Burciaga 11/28/1991 Parents GA/USA
David Burciaga 09/26/1989 Parents GA/USA
NOTES

Media Authoritation

DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
Walk in at CMS