ZAM-DAV-79

Code
ZAM-DAV-79
Mercy ID
V-03041-02
Encounter Date
05/05/2009
Last
Zamora
First
David
DOB
09/27/1979
County
Paulding
Street
3855 Misty Blue Dr.
City
Powderspring
State
GA
Zip
30127-
Home
(678) 384-0324
Cell
(404) 704-2679
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Single Family
Education Level
Some College

Spouse Information

Last
Bedolla
First
Winnie
DOB
09/18/1979
Address
N/A
Telephone
(404) 704-2660
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
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
Efrain Zamora 10/15/1999 Parents GA/USA
Fernando Quintero 01/06/2001 Mother w/Stepfather GA/USA
Kenia Winnie Quintero 03/06/2007 Mother w/Stepfather GA/USA
Omar Ivan Quintero 11/01/2002 Mother w/Stepfather GA/USA
Paulina Quintero 01/07/2005 Mother w/Stepfather 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
Comunidad-Wife