On July 06, 2017 a
Exhibit,Appendix
was filed
involving a dispute between
and
for DIVORCE WITH CHILDREN
in the District Court of Tarrant County.
Preview
233-621760-17
*****THIS FORM IS NOT A PROTEC
TIVE ORDER APPLICATION OR A
PROTECTIVE ORDER***##
SE CTION I: NAMES OF PARTIES
Today’s date: JUV 30,1)
Your name:_ (\APVi4AQ
First
Ange Les ¢ )
Middle
Other last names used
Full name of the person you want a prot
guy
ective order against (List only one person):
Enviaue
OMarried -living tog ether
Middle
What is your current relationshi ip to this perso Mazi
n? (Check ONLY one.)
ceineda
Other last names used
)
OMarried - not living together
OlLiving together - not married ODivorced
OUsed to live together - never married
Ho
ORelated by marriage iological parents of the same child - never marr
ODating or used to date ied
Other - please specify:
Related by blood — please specify: ee
SE CTION e
— II: YOU
SSSR e
PER SON AL INF
SS L S INNORM ATIION
EORMAT ON
Your race or ethnicity: White OAfrican American ClAsian American OPacific Islander
Hispanic ONative American O Other - speci
fy: =
Sex:
Date of Birth: Ou- UU =k 4
OMale tf
‘emale
Age: 3 4
Place of Birth: ViCKI CO
*If you are female, are you pregnant?
OYes OINo DMaybe/don’t know
*If you are female, has this Person ever
al bused you while you were pregnant?L]Yes
Do you have any handicaps or disabilities? OYe: CINo
Ss lo If yes, what is your handicap or disability?
OVisual impairment O)Hearing impairment OMobility or functional impairment
OEmotional or mental disorders O Cardiac and
circulatory dis cases ORespiratory diseases
Other physical handicap or disabling condition
- please specify: SS
Have you ever been arrested, convicted,
oe
put ‘obation, or given a ticket for an act you comm
against ANY PERSON? itted
OYes io If yes, please briefly explain, include dates:
Has anyone ever applied for or gotten a protective
order against you? OYes ‘KINo
If yes, please explain:
How did you find out about this office?
aw enforcement agency - please specify:
COUNT
OJudge or justice of the peace
OMental health services
OHospital/Doctor/Nurse/Medical Professional
OSocial service agency - please specify:
Protective Order Questionnaire
Page 4 of 13 Revised: January 2015
*#4**THIS FORM IS NOT A PROTECTIVE ORDER APPLI
CATION OR A PROTECTIVE ORDER**##*
Other - please specify:
SECTI ON Il: YOUR HOUSEHOL
—— EEDN INFO
EVRRMAT ION
MALION
Where do you live today?
Wie WeretorA py
Street Address Apartment #
Av
City
ington T™ Medi
State Zip Code
When you call 911 from | this address, which police department
responds?
**"Does the abuser know where you live today? WWres ONo
.
Names and contact information for any other ADULTS currently living in your household. Please
explain your relationship with these adults:
What is YOUR mailing address? (if different from above):
Street Address Apartment #
City State Zip Code
Home Phone # Cell Phone #{{74&77 185 Email address: AM
AA N Ae eSR 2C qa |
Does our office have permission to leave messages at the above
phone numbers?
cow
**This office will not leave messages at any number provided Yes LINo
if you are still living with your‘aby user. You will need to
contact
our office to find out the status of your questionnaire.
Ifyou have any minor children, please provide the follow
ing information:
Child’s Name Age Date of Birth Sex Live with you
Napmy 6 Meyia prgeles Id 3-\] -01 OM fF PeYes OINo
OM OF OYes ONo
OM OF OYes No
OM OF DOYes No
OM OF OYes ONo
OM CF OYes ONo
OM OF OYes ONo
Protective Order Questionnaire
Page 5 of 13 Revised: January 2015
*****THIS FORM IS NOT A PROTECTIVE ORDER APPLICATION OR A PROTECTIVE ORDER***#*
If you have minor children NOT living with you, briefly explain why:
Do any of your children have any handicaps or disabilities? Yes PANo
If yes, please indicate type of handicap or disability after that child’s name in the space above.
Is the abuser the parent of any of these children? es ONo Ifyes, which children?
NAOMY Melia Ainaeles
Are there any court orders [temporary or final] that include any of your children? LYes BENo
If known, what court issued the order? Cause# sy
Has the abuser ever harmed any of your children? OYes tuNo If yes, complete the following
Date(s) of abuse:
Name of child/children:
Briefly describe the incident(s):
“a
Has Texas Department of Family and Protective Services (TDFPS— formerly CPS) ever been
notified?** 'Yes CINo
If yes, provide the following information:
04/24/17 fwlington AX
Date City/State” Name of case worker Phone # and extension
Have the police ever been notified of child abuse? OYes OINo
If yes, provide the following information: CPs Vepovt
64b4|2i0w
Date City/State Name of Officer/Detective Phone # Case #
Have criminal charges ever been filed against this person for child abuse? DYes BYNo
If yes, please list the date, county, and case # (if known)
**This office may make a report to TDEPS if we believe a child has been harmed and no feport
has been filed.
Protective Order Questionnaire
Page 6 of 13 Revised: January 2015
*ee*THIS FORM IS NOT A PROTECTIVE ORDE
R APPLICATION OR A PROTECTIVE ORDE
R***#*
E
SEa= CTI
M ONPIV:L O
YOU RY M
EMP E
LOY N
MEN T
T/S /OL
CHO SAND
CH
AND OTH
OTHOER
ER O
CONL
TACT
TAC
INFORMATION
Are you currently employed? Whves ONo = Ifyes, what is your current job?
If you are currently employed, please list anor owner
MY SEN E K(1 652 O13
Employer
Phone #
1900 E. 2aindo| mill fitlington TX
Street Address City
Te
State Zip Code
List the days and‘hours that you work: M-W-
S$ dam +) 4pm
When you call 911 from this address, which police
department responds?:
Does the abuser know where you work? wy
es CINo
Are you currently attending school?
OYes SANo
If you are currently attending school, please list:
School
Phone #
Street Address City State Zip Code
List the days and hours that you attend class
When you call 911 from this address, which police
department responds?:
Does the abuser know where you attend school?
Yes ONo
Fri end or Relative (not living with you) who will alway
s be able to locate you:
Name: SIAN, N AUG Ie. Relationship: + end
Address: HOD HO PAVE DY WS
Street Address rete #
fulingron Wil
State Zip Code
6 wird WY SIT Yo pga
lome Phone Cell Phone Work Phone
Tn the event we cannot find you, may we call the
above named person(s)? yes ONo
Does this office have permission to leave a message with
the above named person(s)? Jafves ONo
Protective Order Questionnaire
Page 7 of 13 Revised: January 2015
*****THIS FORM IS NOT A PROTECTIVE ORDER APPLICATIO
N OR A PROTECTIVE ORDER***#*
SECTION V: INFORMATION ABOUT THE ALLEGED ABUS
ER
Name ROW ENvique Mejia & )
Middle Last Maiden, if applicable
What other names does this person use?
Sex Tale OFemale Age: ok Date of birth: 7 (O-= I9V8
Social Security No. lo LY -X 2 -d Be Place of birth: E SA VAdOV
Driver’s License No, and State:
Home address Stet Di \\
Street Address Apartment #
.
Malington — +¢xq6
City State Zip Code
KI)- BS - 6414
Home Phone No. Cell Phone No.
PATON
When is the best time to find this person at home?
@: O0PIM Monday -
Document Filed Date
July 06, 2017
Case Filing Date
July 06, 2017
Category
DIVORCE WITH CHILDREN
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Preview
233-621760-17 *****THIS FORM IS NOT A PROTEC TIVE ORDER APPLICATION OR A PROTECTIVE ORDER***## SE CTION I: NAMES OF PARTIES Today’s date: JUV 30,1) Your name:_ (\APVi4AQ First Ange Les ¢ ) Middle Other last names used Full name of the person you want a prot guy ective order against (List only one person): Enviaue OMarried -living tog ether Middle What is your current relationshi ip to this perso Mazi n? (Check ONLY one.) ceineda Other last names used ) OMarried - not living together OlLiving together - not married ODivorced OUsed to live together - never married Ho ORelated by marriage iological parents of the same child - never marr ODating or used to date ied Other - please specify: Related by blood — please specify: ee SE CTION e — II: YOU SSSR e PER SON AL INF SS L S INNORM ATIION EORMAT ON Your race or ethnicity: White OAfrican American ClAsian American OPacific Islander Hispanic ONative American O Other - speci fy: = Sex: Date of Birth: Ou- UU =k 4 OMale tf ‘emale Age: 3 4 Place of Birth: ViCKI CO *If you are female, are you pregnant? OYes OINo DMaybe/don’t know *If you are female, has this Person ever al bused you while you were pregnant?L]Yes Do you have any handicaps or disabilities? OYe: CINo Ss lo If yes, what is your handicap or disability? OVisual impairment O)Hearing impairment OMobility or functional impairment OEmotional or mental disorders O Cardiac and circulatory dis cases ORespiratory diseases Other physical handicap or disabling condition - please specify: SS Have you ever been arrested, convicted, oe put ‘obation, or given a ticket for an act you comm against ANY PERSON? itted OYes io If yes, please briefly explain, include dates: Has anyone ever applied for or gotten a protective order against you? OYes ‘KINo If yes, please explain: How did you find out about this office? aw enforcement agency - please specify: COUNT OJudge or justice of the peace OMental health services OHospital/Doctor/Nurse/Medical Professional OSocial service agency - please specify: Protective Order Questionnaire Page 4 of 13 Revised: January 2015 *#4**THIS FORM IS NOT A PROTECTIVE ORDER APPLI CATION OR A PROTECTIVE ORDER**##* Other - please specify: SECTI ON Il: YOUR HOUSEHOL —— EEDN INFO EVRRMAT ION MALION Where do you live today? Wie WeretorA py Street Address Apartment # Av City ington T™ Medi State Zip Code When you call 911 from | this address, which police department responds? **"Does the abuser know where you live today? WWres ONo . Names and contact information for any other ADULTS currently living in your household. Please explain your relationship with these adults: What is YOUR mailing address? (if different from above): Street Address Apartment # City State Zip Code Home Phone # Cell Phone #{{74&77 185 Email address: AM AA N Ae eSR 2C qa | Does our office have permission to leave messages at the above phone numbers? cow **This office will not leave messages at any number provided Yes LINo if you are still living with your‘aby user. You will need to contact our office to find out the status of your questionnaire. Ifyou have any minor children, please provide the follow ing information: Child’s Name Age Date of Birth Sex Live with you Napmy 6 Meyia prgeles Id 3-\] -01 OM fF PeYes OINo OM OF OYes ONo OM OF OYes No OM OF DOYes No OM OF OYes ONo OM CF OYes ONo OM OF OYes ONo Protective Order Questionnaire Page 5 of 13 Revised: January 2015 *****THIS FORM IS NOT A PROTECTIVE ORDER APPLICATION OR A PROTECTIVE ORDER***#* If you have minor children NOT living with you, briefly explain why: Do any of your children have any handicaps or disabilities? Yes PANo If yes, please indicate type of handicap or disability after that child’s name in the space above. Is the abuser the parent of any of these children? es ONo Ifyes, which children? NAOMY Melia Ainaeles Are there any court orders [temporary or final] that include any of your children? LYes BENo If known, what court issued the order? Cause# sy Has the abuser ever harmed any of your children? OYes tuNo If yes, complete the following Date(s) of abuse: Name of child/children: Briefly describe the incident(s): “a Has Texas Department of Family and Protective Services (TDFPS— formerly CPS) ever been notified?** 'Yes CINo If yes, provide the following information: 04/24/17 fwlington AX Date City/State” Name of case worker Phone # and extension Have the police ever been notified of child abuse? OYes OINo If yes, provide the following information: CPs Vepovt 64b4|2i0w Date City/State Name of Officer/Detective Phone # Case # Have criminal charges ever been filed against this person for child abuse? DYes BYNo If yes, please list the date, county, and case # (if known) **This office may make a report to TDEPS if we believe a child has been harmed and no feport has been filed. Protective Order Questionnaire Page 6 of 13 Revised: January 2015 *ee*THIS FORM IS NOT A PROTECTIVE ORDE R APPLICATION OR A PROTECTIVE ORDE R***#* E SEa= CTI M ONPIV:L O YOU RY M EMP E LOY N MEN T T/S /OL CHO SAND CH AND OTH OTHOER ER O CONL TACT TAC INFORMATION Are you currently employed? Whves ONo = Ifyes, what is your current job? If you are currently employed, please list anor owner MY SEN E K(1 652 O13 Employer Phone # 1900 E. 2aindo| mill fitlington TX Street Address City Te State Zip Code List the days and‘hours that you work: M-W- S$ dam +) 4pm When you call 911 from this address, which police department responds?: Does the abuser know where you work? wy es CINo Are you currently attending school? OYes SANo If you are currently attending school, please list: School Phone # Street Address City State Zip Code List the days and hours that you attend class When you call 911 from this address, which police department responds?: Does the abuser know where you attend school? Yes ONo Fri end or Relative (not living with you) who will alway s be able to locate you: Name: SIAN, N AUG Ie. Relationship: + end Address: HOD HO PAVE DY WS Street Address rete # fulingron Wil State Zip Code 6 wird WY SIT Yo pga lome Phone Cell Phone Work Phone Tn the event we cannot find you, may we call the above named person(s)? yes ONo Does this office have permission to leave a message with the above named person(s)? Jafves ONo Protective Order Questionnaire Page 7 of 13 Revised: January 2015 *****THIS FORM IS NOT A PROTECTIVE ORDER APPLICATIO N OR A PROTECTIVE ORDER***#* SECTION V: INFORMATION ABOUT THE ALLEGED ABUS ER Name ROW ENvique Mejia & ) Middle Last Maiden, if applicable What other names does this person use? Sex Tale OFemale Age: ok Date of birth: 7 (O-= I9V8 Social Security No. lo LY -X 2 -d Be Place of birth: E SA VAdOV Driver’s License No, and State: Home address Stet Di \\ Street Address Apartment # . Malington — +¢xq6 City State Zip Code KI)- BS - 6414 Home Phone No. Cell Phone No. PATON When is the best time to find this person at home? @: O0PIM Monday -