BAR-BER-58

Code
BAR-BER-58
Mercy ID
V-02354-01
Encounter Date
10/17/2006
Last
Bardales
First
Bertilda
DOB
12/12/1958
County
Dekalb
Street
5032 Chamblee Tucker
City
Doraville
State
GA
Zip
30340-
Home
(678) 754-6562
Family Status
Two parent family w/children
COB
Honduras
Gender
Female
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Matamoros
First
Jose
DOB
N/A
Address
N/A
Telephone
N/A
COB
Honduras
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
Ana Jocelyn Matamoros 07/13/1999 Parents GA/USA
Trece Bardales 03/19/2005 Parents GA/USA
NOTES

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
Linea-Juana