BAC-ELM-79

Code
BAC-ELM-79
Mercy ID
V-03222-02
Encounter Date
12/15/2009
Last
Baca
First
Elmer
DOB
08/11/1979
County
Cobb
Street
825 Powder Spring St.
City
Marietta
State
GA
Zip
30064-
Cell
(678) 392-9752
Family Status
Single adult
COB
Honduras
Gender
Male
Housing
Doubling Up
Education Level
some high school

Spouse Information

Last
Midence
First
Carmen
Middle
M.
DOB
05/21/1984
Address
N/A
Telephone
N/A
COB
Honduras
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
Anthony Baca 03/16/2008 Mother GA/USA
Christopher Baca N/A Mother 1º pareja-Delmi Escoto-Jonesboro
Elmer Baca N/A Mother 1º pareja-Delmi Escoto-Jonesboro

Former Spouse 1 Information

Last
Escoto
First
Delmi
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
J. Manzo
Data Entry
J. Manzo
Referred By
compañera/linea/Juana