BAL-MAR-75

Code
BAL-MAR-75
Mercy ID
V-02560-01
Encounter Date
08/01/2007
Last
Balderas
First
Maria irene
DOB
06/13/1975
County
Dekalb
Street
999 no lo dio
City
Lithonia
State
GA
Zip
30058-
Cell
(229) 869-9635
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
H.S. equivalency diploma

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
N/A
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
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
Fatima Carmona 12/18/2002 Mother GA/USA

Former Spouse 1 Information

Last
Carmona
First
Jose
DOB
09/10/1976
Telephone
N/A
COB
USA
Home Owner
No
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