ALV-SEL-82

Code
ALV-SEL-82
Mercy ID
V-02290-01
Encounter Date
07/25/2006
Last
Alvahuante
First
Selene
DOB
01/29/1982
County
Gwinnett
Street
1470 Boggs Rd. # 503
City
Duluth
State
GA
Zip
30096-
Cell
(678) 755-1354
Other
(770) 572-9619
Family Status
Single parent w/children
COB
Mexico
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
N/A
COB
N/A
Home Owner
No
Driver
No
Home Owner
YES
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
YES
Stranger
No

Children

NAME DOB LIVING WITH STATE/COUNTRY
Luis Manuel Gonzalez 10/08/2005 Mother GA/USA

Former Spouse 1 Information

Last
Gonzalez
First
Oscar
DOB
11/06/1976
Telephone
N/A
COB
Cuba
Home Owner
No
NOTES
El telefono es de la Mamá

Media Authoritation

NO DOY PERMISO
DOY PERMISO
No
Limitado Impresos
No
Limitado Educativo
No
Limitado CL
No
Intake
G. Landeros
Data Entry
J. Manzo
Referred By
Asociacion Latina