VEL-ELE-67

Code
VEL-ELE-67
Mercy ID
V-01450-01
Encounter Date
12/29/2003
Last
Velasquez
First
Elena
DOB
02/11/1967
County
Dekalb
Street
1368 N. Cliff Valley Way G5
City
Atlanta
State
GA
Zip
30319-
Home
(404) 633-4107
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school

Spouse Information

Last
Velasquez
First
Humberto
DOB
04/14/1957
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
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
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
Adriana Velasquez 06/20/2000 Parents GA/USA
Ana Juritza Velasquez 02/14/1999 Parents GA/USA
Humberto Velasquez 04/22/2001 Parents GA/USA
Jessenia Velasquez 05/17/1995 Parents GA/USA
Juliana Velasquez 09/07/2002 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Manzo
Data Entry
K. Aleman
Referred By
x3737 Damaryz