ZAM-ADR-76

Code
ZAM-ADR-76
Mercy ID
V-02576-01
Encounter Date
08/23/2007
Last
Zamora
First
Adriana
DOB
01/09/1976
County
Gwinnett
Street
403 Saint Marlowe Dr.
City
Lawrenceville
State
GA
Zip
30044-
Cell
(678) 516-7473
Family Status
Single parent w/children
COB
Perú
Gender
Female
Housing
Doubling Up
Education Level
College Degree

Spouse Information

Last
Aboytes
First
Valentin
DOB
12/18/1979
Address
N/A
Telephone
N/A
COB
Mexico
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
Ariana F. Montenegro 04/19/2000 Mother GA/USA
Juan P. Montenegro 06/28/2001 Mother GA/USA

Former Spouse 1 Information

Last
Montenegro
First
Omar
DOB
02/28/1975
Telephone
N/A
COB
N/A
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