BAR-MON-83

Code
BAR-MON-83
Mercy ID
V-03195-01
Encounter Date
10/27/2009
Last
Barrita
First
Monica
DOB
11/04/1983
County
Dekalb
Street
416 Brook Ridge
City
Doraville
State
GA
Zip
30340-
Cell
(678) 760-1859
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
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
Carlos M. Avendaño 03/05/2004 Mother GA/USA
Elizabeth Avendaño 11/17/2002 Mother GA/USA

Former Spouse 1 Information

Last
Avendaño
First
Alejandro
DOB
02/25/1982
Telephone
N/A
COB
Mexico
Home Owner
No
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
Policia/linea-Juana