TEL-ANT-78

Code
TEL-ANT-78
Mercy ID
V-03116-01
Encounter Date
07/08/2009
Last
Telles
First
Antonia
DOB
01/17/1978
County
Clayton
Street
4378 Hwy 42 Lot 4
City
Elenwood
State
GA
Zip
30294-
Cell
(404) 389-6634
Family Status
Single parent w/children
COB
Guatemala
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
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
Adeli Sandoval 06/15/1999 Mother GA/USA
Antony Sandoval 01/05/2003 Mother GA/USA

Former Spouse 1 Information

Last
Sandoval
First
Rubi
DOB
09/09/1975
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