VEG-PAU-67

Code
VEG-PAU-67
Mercy ID
V-01482-01
Encounter Date
02/09/2004
Last
Vega
First
Maria paulina
DOB
02/01/1967
County
Gwinnett
Street
3221 Fescue Circle
City
Lawrenceville
State
GA
Zip
30044-
Cell
(404) 384-2028
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Mondragon
First
Oscar
DOB
N/A
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
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
Cintia Mandragon 01/09/1998 N/A GA/USA
Daniel Mondragon 08/28/1991 N/A GA/USA
Jenifer Mondragon 10/23/1995 N/A GA/USA
Jesus Perandi 07/12/2003 N/A GA/USA
Samanta Mondragon 11/16/2000 N/A GA/USA

Former Spouse 1 Information

Last
Mondragon
First
Oscar
DOB
10/22/1971
Telephone
N/A
COB
N/A
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
K. Aleman
Referred By
x1375 Damaryz/Radio Mex