SOR-MAR-77

Code
SOR-MAR-77
Mercy ID
V-03476-01
Encounter Date
11/15/2010
Last
Soriano
First
Maria del carmen
DOB
07/06/1977
County
Fulton
Street
4689 Roswell Rd. Ne. # L-8
City
Atlanta
State
GA
Zip
30342-
Cell
(678) 600-6652
Other
(404) 573-6238
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school

Spouse Information

Last
Tavera
First
Fernando
DOB
01/03/1977
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
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
Jesse Perez 08/08/2006 Parents GA/USA
Samantha Perez 10/20/2000 Parents GA/USA

Former Spouse 1 Information

Last
Perez
First
Jose luis
DOB
05/06/1971
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
G. Landeros
Data Entry
J. Manzo
Referred By
Jacqueline