AVI-LET-73

Code
AVI-LET-73
Mercy ID
V-03087-01
Encounter Date
06/09/2009
Last
Avila
First
Leticia
DOB
04/14/1973
County
Clayton
Street
955 Pinelen Dr.
City
Forest park
State
GA
Zip
30297-
Home
(678) 789-0270
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school

Spouse Information

Last
N/A
First
N/A
DOB
N/A
Address
N/A
Telephone
N/A
COB
Mexico
Home Owner
No
Driver
No
Home Owner
YES
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
YES
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
Angela Avila B 12/29/2002 Mother GA/USA
Brian Avila B. 11/26/2000 Mother GA/USA
Natale Avila B 08/03/2004 Mother GA/USA

Former Spouse 1 Information

Last
Avila
First
Mario
DOB
02/19/1975
Telephone
N/A
COB
N/A
Home Owner
YES
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