ALV-TER-76

Code
ALV-TER-76
Mercy ID
V-03100-01
Encounter Date
06/23/2009
Last
Alvarez
First
Teresa
DOB
07/22/1976
County
Cobb
Street
1750 Mary Ada Dr.
City
Kennesaw
State
GA
Zip
30144-
Cell
(678) 468-0574
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
High school graduate

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
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
YES
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
Aldair Ulloa 01/17/2005 Parents GA/USA
Emily Ulloa 12/21/2006 Parents GA/USA
Isac Alvarez 06/27/2003 Mother w/Stepfather GA/USA

Former Spouse 1 Information

Last
Ulloa
First
Luis
DOB
02/17/1984
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
J. Perez
Data Entry
J. Manzo
Referred By
linea-Juana/Ximena y Jessica