ANG-ANA-70

Code
ANG-ANA-70
Mercy ID
V-02158-01
Encounter Date
02/06/2006
Last
Angulo
First
Ana yency
DOB
10/03/1970
County
Gwinnett
Street
2905 Centential Parkway
City
Lawrenceville
State
GA
Zip
30043-
Home
(770) 904-0664
Cell
(678) 913-5687
Family Status
Two parent family w/children
COB
Costa Rica
Gender
Female
Housing
Not Homeless
Education Level
some high school

Spouse Information

Last
Fernandez
First
Martin
DOB
N/A
Address
N/A
Telephone
N/A
COB
Costa Rica
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
No
Consentimiento De Participar
No

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
YES

Children

NAME DOB LIVING WITH STATE/COUNTRY
Alejandro Mora 07/31/1988 N/A GA/USA
Ana Maria Mora 09/17/1990 N/A GA/USA
Juan Mora 02/11/1996 N/A GA/USA
Samantha Fernandez 03/21/2000 Parents GA/USA
NOTES

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
J. Perez
Data Entry
R. Gonzalez
Referred By