TOR-CLA-63

Code
TOR-CLA-63
Mercy ID
V-03107-01
Encounter Date
06/29/2009
Last
Torres
First
Clara
DOB
06/18/1963
County
Fortpayne alabama
Street
0309 Thousand Rd.
City
Valleyhead
State
AL
Zip
35989-
Cell
(256) 630-4773
Family Status
Single adult
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
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
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
Leonardo Daniel Martinez 11/06/1993 Mother GA/USA
Marco Antonio martinez 07/13/2003 Mother GA/USA
Samuel David Martinez 08/31/2000 Mother GA/USA

Former Spouse 1 Information

Last
Martinez
First
Leopoldo
DOB
N/A
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