XIO-SON-66

Code
XIO-SON-66
Mercy ID
V-01264-01
Encounter Date
06/24/2003
Last
Xicara
First
Sonia
DOB
12/24/1966
County
Gwinnett
Street
1435 Danbury Dr.
City
Norcross
State
GA
Zip
30093-
Cell
(678) 508-2711
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
High school graduate

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
(404) 840-9642
COB
N/A
Home Owner
YES
Driver
No
Home Owner
YES
SOLO
No
Court Mandated
No
Program Completed
YES
DFCS Mandated
YES
California
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
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
Edgar Lep 10/18/1991 Mother GA/USA
Emily Lep 08/25/2005 Mother GA/USA
Jorge Lep 03/19/2004 Mother GA/USA
Monica Lep 03/15/1993 Mother GA/USA

Former Spouse 1 Information

Last
Lep
First
Edgar
DOB
05/08/1972
Telephone
N/A
COB
Guatemal
Home Owner
No
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
K. Aleman
Referred By
x3737 Damaryz/ Associacion Latina