ANT-MAR-78

Code
ANT-MAR-78
Mercy ID
V-02435-02
Encounter Date
03/13/2007
Last
Antonio
First
Martin
DOB
06/18/1978
County
Dekalb
Street
3160 Buford Hwy. I-2
City
Atlanta
State
GA
Zip
30329-
Cell
(678) 858-9019
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Not Homeless
Education Level
Grade school

Spouse Information

Last
Herrera
First
Celia
DOB
01/20/1968
Address
N/A
Telephone
(678) 858-0730
COB
Mexico
Home Owner
No
Driver
No
Home Owner
No
SOLO
No
Court Mandated
YES
Program Completed
YES
DFCS Mandated
No
Alcohol & Drug
YES
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
Abigail Gutierrez N/A Mother w/Stepfather GA/USA
Alex Antonio 01/03/2007 Parents GA/USA
Alfredo David Gutierrez N/A Mother w/Stepfather GA/USA
Fernanda Gutierrez N/A Mother w/Stepfather GA/USA
Humberto Gutierrez N/A Mother w/Stepfather GA/USA
Jorge Antonio 08/02/2005 Parents GA/USA
Kevin Antonio 06/02/2004 Parents 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
J. Manzo
Referred By
Felipe