GAL-ROS-73

Code
GAL-ROS-73
Mercy ID
V-02438-01
Encounter Date
03/13/2007
Last
Galan
First
Rosaura
DOB
09/03/1973
County
Fulton
Street
5501 Glenridge Dr. Apt. 905
City
Atlanta
State
GA
Zip
30342-
Cell
(404) 309-5419
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Single Family
Education Level
Some College

Spouse Information

Last
Gooden
First
Dwayne
DOB
02/17/1968
Address
El compañero es policia
Telephone
N/A
COB
USA
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
YES
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
Samanta Frija Khanimov 04/24/2007 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Khanimov
First
Abo
DOB
02/17/1979
Telephone
N/A
COB
Russia
Home Owner
No
NOTES

Media Authoritation

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