CAR-LET-78

Code
CAR-LET-78
Mercy ID
V-03270-01
Encounter Date
02/19/2010
Last
Carmona
First
Leticia
DOB
08/12/1978
County
Fulton
Street
5555 Roswell Road
City
Atlanta
State
GA
Zip
30342-
Cell
(678) 558-7287
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
YES
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
Daniel Guzman 12/22/2007 Mother GA/USA
David Guzman 09/15/1998 Mother GA/USA
Keven Guzman 12/12/1996 Mother GA/USA

Former Spouse 1 Information

Last
Guzman
First
Severo
DOB
12/23/1978
Telephone
N/A
COB
Mexico
Home Owner
YES
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
Jacqueline/Entrevista