DAY-MAR-54

Code
DAY-MAR-54
Mercy ID
V-01731-01
Encounter Date
10/19/2004
Last
Day
First
Marta cecilia
DOB
05/27/1954
County
Gwinnett
Street
3942 Hooch Landing
City
Duluth
State
GA
Zip
30097-
Home
(770) 622-3882
Cell
(423) 544-9262
Family Status
Single adult
COB
Colombia
Gender
Female
Housing
Transitional
Education Level
College Degree

Spouse Information

Last
Day
First
Clarence
DOB
06/26/1953
Address
N/A
Telephone
N/A
COB
USA
Home Owner
YES
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
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
Marta Juliana 10/17/1974 Adulto/Casado 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
Damaryz and Latin American Assoc.