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Home My WebLink About01-0652 FX ,- , '-' "-,-<- "'-'~, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TRACY L. McMICHAEL, Plaintiff v. : NO. 01- & S :J- Civil Term WILLIAM C. McMICHAEL, Defendant IN CUSTODY ORDER OF COURT day of , 2001, of the attached Complaint, it is hereby parties and their respective counsel appear , the Conciliator, at on the day of , 2001, at ___.m., for a Pre-Hearing Custody Conference. At such Conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the Court and to enter into a temporary Order. All children age five or older may also be present at the conference. Failure to appear at the Conference may provide grounds for entry of a temporary or permanent Order. AND NOW, this upon consideration directed that the before FOR THE COURT: By: Custody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the Court. You must attend the scheduled Conference or Hearing. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 ~ ~ '. ~" I" .._~~.~. _ "~.'~ . ~~ I - -" -'\f~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TRACY L. MCMICHAEL, Plaintiff . . . . NO. 01- (,S,;u Civil Term v. WILLIAM C. McMICHAEL, Defendant : : IN CUSTODY COMPLAINT IN CUSTODY AND NOW comes the Plaintiff, TRACY L. McMICHAEL, by and through her attorney, Maryann Murphy, Esquire, of MidPenn Legal Services, and respectfully files this Complaint in Custody, and in support thereof avers as follows: 1. plaintiff is TRACY L. McMICHAEL who resides at 144 West Orange Street, Shippensburg, Cumberland County, Pennsylvania. 2. Defendant is WILLIAM C. McMICHAEL who resides at 225 Minnie Road, Chambersburg, Franklin County, Pennsylvania. 3. The minor children involved in this action are: JESSE McMICHAEL, born July 27, 1986 AARON McMICHAEL, born August 23, 1989 and EMILY McMICHAEL, born November 14, 1996 ,~^., <' ll~' WftW~;t 4. Plaintiff is the biological mother of the minor children: 5. Defendant is the biological father of the minor children. 6. JESSE was born out of wedlock. AARON and EMILY were born in wedlock. 7. The children are presently in the custody of Plaintiff. 8. During the lifetime of the children, they have resided with the following persons at the following addresses: Dates Addresses Persons birth-1987 Bradford. PA Plaintiff/Defendant 1987-1988 New York Plaintiff/Defendant 1988-1990 Lemoyne, PA Plaintiff/Defendant 1990-5/1998 Mechanicsburg, PA Plaintiff/Defendant 5/1998-12/1998 Reynoldsville, PA Plaintiff 12/1998-10/2000 Shippensburg, PA Plaintiff/Defendant 10/2000-present 144 West Orange Street Shippensburg, PA Plaintiff 9. Plaintiff and Defendant are married to each other. 10. Plaintiff has not participated as a party or witness, or in any other capacity, in other litigation concerning the custody of the minor children in this or any other Court, except as set - ~~~UI-. ~=._. ',,;>., 'J- =~' ;..~,*.~, forth above. 11. Plaintiff has no information of a custody proceeding concerning the children pending in a Court of this Commonwealth or in any Court. 12. Plaintiff does not know of a person not a party to the proceedings who has physical custody of the minor children, or claims to have custody or visitation rights with respect to the children. 13. Each parent whose parental rights to the minor children have not been terminated, and the person who has physical custody of the children, have been named as parties to this action. There are no other persons known to have or claim a right to custody or visitation of the children and therefore, no further notice of the pendency of this action and the right to intervene shall be given, other than to the parties named herein. 14. The best interests and permanent welfare of the minor children will be served by granting primary physical custody to Plaintiff. WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter a Decree granting her primary physical custody of ~~ ~. ~ "-..-..",...J JESSE, AARON and EMILY. Respectfully submitted: C_', <~_ ~. , "'nil' 1'LJ-i,- Maryann Murphy, Esq ir MID PENN LEGAL SERVICES 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 I.D. #61900 Attorney for plaintiff ,,~' , ~- '" - ^-~ ~.. .J.:. " , 1- '-',' , ~ ,.-1 ~ VERIFICATION I, TRACY L. McMICHAEL, do hereby verify that I am the Plaintiff in the within action, and that the statements made in the foregoing Complaint in Custody are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. 4904, relating to unsworn falsification to authorities. 1-/9-~OI Date ~~J?!( ~U TRACY L. McMICHAEL ;'~~~_._l_ . .....J M . :::', IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TRACY L. McMICHAEL, Plaintiff : NO. 01- Ci viI Term v. . . WILLIAM C. McMICHAEL, Defendant IN CUSTODY CERTIFICATE OF SERVICE I, Maryann Murphy, Esquire, do hereby certify that on the day of , 2001, a true and correct copy of the Complaint in Custody was served upon the Defendant by placing a copy of same in the United States Mail, first class, postage prepaid, certified/restricted delivery, addressed as follows: william C. McMichael 225 Minnie Road Chambersburg, PA 17201 Date: Murphy, Esqui e MID PENN LEGAL SERVICES 8 Irvine Row Carlisle, PA 17013 (717) 243-9400 I.D.#61900 Attorney for Plaintiff . F!I r'O-niCFIf'C 'f".r 1', ,...~. ',--: ......, V' Jt" _,' -,",""'-<-<1 ~ .>, " ,'. i;~'_.'. W1~'VYI"IAny _" ',I..) '\11 ." d' ~.r~~.~ 'is. 0 I ~'O . ."". _ . lVPLAI~'-- ...:__........,I:;s.---- , ,"'lC~~ ......,... " . /)\J~..ftj ! --'"" I ....-.- .' - OT!\"'Y O! Y~J 31 Pt'1 2: 45 CI it...~(.j-':.".,' r 1.' VIl:Ch:i-.,j..:il r'OUNlY ,"C_' "'1-' V J t"t:t\NSYLV!~NiA ~ ~ -'~.',~, '.~., ,~-,~ ~ - - ~ - .~., ~ --- ,_....', ,":",v.- -.'-iiiJi. ; . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CML ACTION - LAW TRACY L. McMICHAEL, Plaintiff : NO. 0Sd-. Civil Term v. : IN CUSTODY WILLIAM C. McMICHAEL, Defendant PRAECIPE TO PROCEED IN FORMA PAUPERIS To the Prothonotary: Kindly allow, TRACY L. McMICHAEL, Plaintiff, to proceed in forma vauveris. I, Maryann Murphy, Esquire, of MidPenn Legal Services, attorney for the party proceeding in forma vauveris, certify that I believe the party is unable to pay the costs and that I am providing free legal services to the party. The party's affidavit showing inability to pay the costs of litigation is attached hereto. l~ f~ -1 t.i:! J~ - ~'7 1- "'~: , I . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TRACY L. McMICHAEL, Plaintiff : NO. 01- (,,!t;L Civil Term v. : IN CUSTODY WILLIAM C. McMICHAEL, Defendant AFFIDAVIT IN SUPPORT OF PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS 1. I am TRACY L. McMICHAEL, Plaintiff in the above matter and because of my financial condition am unable to pay the fees and costs of prosecuting, defending, or appealing the action or proceeding. 2. I am unable to obtain funds from anyone, including my family and associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct. (a) Name: TRACY L. McMICHAEL Address: 144 West Oranl!e Street. ShiDoensburg:. PA 17057 (b) Social Security Number: 178-62-4232 If you are presently employed, state Employer: Dam Martin Countrv Comer Retail Catering: Address: 20 West Oranl!e Street. Shiooensburl!. PA 17257 Salary or wages per month: $ 998.00 Type of work: clerk - "" "~ "' If you are presently unemployed, state NIA Date of last employment: N/ A Salary or wages per month: N/A Type of work: N/A (c) Other income within the past twelve months Business or profession: -0- Other self-employment: -0- Interest: -0- Dividends: -0- Pension and annuities: -0- Social Security benefits: -0- Support payments: $400.00 Disability payments: -0- Unemployment compensation and supplemental benefits: -0- Workman's compensation: -0- Public Assistance: -0- Other: -0- (d) Other contributions to household support (Wife)(Husband) Name: N/A the parties are seoarated If your (husband) (wife) is employed, state Employer: N/A ," ~~G' _.,,~"~. -- - 1l!f~l.iil);-' -~~ .' Salary or wages per month: N/A Type of work: N/A Contributions from children: -0- (e) Property owned Cash: -0- Checking Account: -0- Savings Account: -0- Certificates of Deposit: -O- Real Estate (including home): N/A Motor vehicle: Make Chrvsler 5th Avenue Year Cost $500.00 Stocks; bonds: -0- Other: -0- (f) Debts and obligations Mortgage: Rent: Amount owed Loans: -0- $475.00 -0- Monthly Expenses: aooroximately $1000.00 (g) Persons dependent upon you for support (Wife) (Husband) Name: N/A N 1988 -0- """. ~::M-~~ ~'~ 'tillE~.,,~~",=~~ . .~ . ~ -~ii: '"14 Children, if any: Name: Jesse Age: 14 Name: Aaron Age: 11 Name: Emilv Age: 4 4. I understand that I have a continuing obligation to inform the court of improvement in my financial circumstances which would permit me to pay the costs incurred herein. 5. I verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. Date: /~ /:J.. .Of ~;t(yp TRAC L. McMICHAEL ,.01 _" FlLI~[}-()(}'/CE lv'," I ,,,,-,,.'Cr"JOTId"lY , 'J,_.;" "..:1 -,~ IfVl () I JMO I PM 2: 1.5 CU' "r""", ., "', r~' '/"T'( '1Y!L:-k:r:U-li\Ju ,j.)l) \j PENNSYLVANIA I ,~ 1 I I I I ~ '~ 1< ~ o e '~ 1 '$ :1, ~ ~ ~ I I ~ " ~ I 1 i II ~ ,-~"-= ~,"""'" - _.._=~~, L:i .' . ~ TRACY L. MCMICHAEL PLAINTIFF V. WILLIAM C. MCMICHAEL DEFENDANT IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA 01-652 CIVIL ACTION LAW IN CUSTODY ORDER OF COURT AND NOW. this 5th day of February, 2001, upon consideration of the attached Complaint, it is hereby directed that the parties and their respective counsel appear beforeJacqueline M. Verney, Esq. , the conciliat at 4th Floor. Cumberland Connry Courthouse, Carlisle on the 7th day of March , 200 I, at 9:30 a.m. for a Pre-Hearing Custody Conference. At such conference, an effort will be made to resolve the issues in dispute; or if this cannot be accomplished, to define and narrow the issues to be heard by the court, and to enter into a temporary order. All children age five or older may also be present at the conference, Failure to appear at the conference may provide grounds for entry of a temporary or permanent order. FOR THE COURT, By: Isl ac ueline M. Vern Es Custody Conciliator The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilites Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the court, please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the court, You must attend the scheduled conference or hearing. YOU SHOULD TAKE TillS PAPER TO YOUR ATTORNEY AT ONCE. IF YOU DO NOT HAVE AN ATTORNEY OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 Telephone (717) 249-3166 ~ ;)-'6.tJ/ d VtJ/ .Jf.n l ~~,.,~~~, . __~1ilil111 ~T' OF . ~D"'''Cq''r~:E ,1OIhlY o I FEB - 8 '/:1,>1' Q: t') i > ..J oJ. ....'.11'-' "." .....vi.,rhi-j..ii ,:i\J'i" ""Uj\riY "~''-- '-' .,',..) 0...) '\l PEI\INSYLW\Nil\ w- ~ ~~ i; !-,5, ~~~)4A~ 6df!" ~ iI1~ ~ a4 V~ ,." ~ 11/!.l.~~""'1!'''~1l~t.'ii\!1l.'11'o'''.1<~Jii''~1!I~M.'!;-~J~~~~~:...:::::.::__.:,-..__-,-____2!''''' "" . I t' ~, ;,~^, .^~;:_< ". c'.~, "'~''- ~'__'" "':; IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TRACY L. McMICHAEL, Plaintiff : No. 2001-652 Civil Term v. WILLIAM C. McMICHAEL, Defendant : IN CUSTODY PRAECIPE TO REINSTATE ACTION To the Prothonotary: Please reinstate the above action in Custody. Respectfully submitted: Maryann urphy, Esquire MidPenn Legal Services 8 Irvine Row Carlisle, P A 17013 (717) 243-9400 !.D. # 61900 Attorney for Plaintiff " II; i :,;T:",6,;')8 l-\ \ \:':.:-n ~/ n Fh :~: tr 9 ,/ \1.'-' "...... " " -"", ," " . i'--'., ; f'--l\ F\rr'l CUrI\;'~:,~:y.~r'-\"h.l ..j......,.....I~I. P-'-'''iQ''/'llo,'ill\ C'\,\l'A)lL,) ,1\.. I I , i , , .~ ';g ~ ,{11 11 .~ I . I i I I 1 " ',1\i v;. f IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW TRACY L. McMICHAEL, Plaintiff No. 01-652 Civil Term v. WILLIAM C. McMICHAEL, Defendant IN CUSTODY ORDER OF COURT AND NOW, this 1.::;1,..1 day of MAtt CJ.( ,2001, upon presentation of the attached Stipulation for Entry of Custody Order, IT IS HEREBY ORDERED AND DECREED that custody of the minor children, JESSE McMICHAEL, born July 27, 1986; AARON McMICHAEL, born August 23,1989; and EMILY McMICHAEL, born November 14,1996, is awarded as follows: I. MOTHER shall have primary physical and legal custody of the minor children. 2. FATHER shall have partial physical custody of the minor children on alternate weekends from Friday at 5:00 p.m. until Sunday at 5:00 p.m. 3. The parents shall share or alternate the holidays with the minor children each year. The specific times shall be detenruned by mutual agreement of MOTHER and FATHER. 4. MOTHER shall have the children on Mother's Day and F ATHER shall have the children on Father's Day, regardless of the usual alternating weekend schedule. 5. By mutual consent of the parents, a modified schedule may be agreed upon between t . wc~._, <_.. \ oem ~ , , , ',,- '"',. r l~,,~ ,.< "I 1-,1 C[' i"l;,::Flr"f: jl.'_1,_-,--',j) 1'.1.... , 0t:' -1"."_.: :>/li~.!,C'~\!OTAR\' '.j, O\~iMl2J Pr112:24 C' 'u ,', "', c,r'l ',er\l UiVi::':L:i'\Lf\i"~Lj U Jh i 1 PH~NSYLVN~i!\ , . "'.'~~ ~~ l~, .'q , nll.,..,.~ ...~II!1ill~ltI?'~'I'>llPti(o,~"""'l\!lIH~~~~I$.li!/li!!l~....-'1""'?'~''''. ~ __I "_"_. _..< -'. . ',"'~" ,'; ';'\k,_' ,,- ,,~,. ,-', ,',cL'~'fu.;. , them for and in the best interests of the minor children. 6. Both parents shall permit reasonable telephone access between the children and the other parent. MOTHER and FATHER shall provide each other with a current telephone number and address. 7. Neither parent shall use illegal drugs or abuse alcohol while the children are in their custody, and to the extent possible, they shall ensure that third parties do not use illegal drugs or abuse alcohol in the presence of the children. 8. For purposes of visitation, FATHER shall provide transportation or shall arrange transportation with a mutually agreed upon third party. Currently the parents live approximately ten (10) miles apart. Should MOTHER move more than ten (10) miles from her current residence, she shall be responsible for transportation of the children. 9. This Order shall replace and supercede any and all prior Custody Orders, and shall remain in full force and effect until further Order of Court. BY THE COURT: /fYAJ / l~,~~)~\ o ~V J. j" , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA , CIVIL ACTION - LAW TRACY L. McMICHAEL, Plaintiff No. 01-652 Civil Term v. WILLIAM C. McMICHAEL, Defendant IN CUSTODY STIPULATION FOR ENTRY OF A CUSTODY ORDER The parties to this action, TRACY L. McMICHAEL (hereinafter referred to as "MOTHER"), and WILLIAM C. McMICHAEL (hereinafter referred to as "FATHER"), desiring to amicably settle and resolve all outstanding issues concerning custody and partial custody with respect to the minor children involved in this action: JESSE McMICHAEL, born July 27, 1986; AARON McMICHAEL, born August 23, 1989; and EMILY McMICHAEL, born November 14, 1996, hereby stipulate and agree to the entry of an Order of Court awarding custody of JESSE, AARON and EMILY as follows: I. The parents agree that MOTHER shall have primary physical and legal custody of the minor children. 2. The parents agree that FATHER shall have partial physical custody of the minor children on alternate weekends from Friday at 5:00 p.m. until Sunday at 5:00 p.m. 3. The parents agree to share or alternate the holidays with the minor children each year. The specific times shall be determined by mutual agreement of MOTHER and F ATHER. 4. The parents agree that MOTHER shall have the children on Mother's Day and F ATHER }f;! ,. -'^ I' '" .,', > -~~."'= ", ",..,~ . ."., ,.p" '~~i ;- shall have the children on Father's Day, regardless ofthe usual alternating weekend schedule. 5. By mutual consent of the parents, a modified schedule may be agreed upon between them for and in the best interests of the minor children. 6. Both parents agree to permit reasonable telephone access between the children and the other parent. MOTHER and FATHER agree to provide each other with a current telephone number and address. 7. The parents agree that neither shall use illegal drugs or abuse alcohol while the children are in their custody, and to the extent possible, they shall ensure that third parties do not use illegal drugs or abuse alcohol in the presence of the children. 8. The parties agree that this Agreement shall be submitted to the Court of Common Pleas of Cumberland County for approval and for entry of an Order awarding custody and partial custody as se~h herein, and the parties hereby request that this Honorable Court enter such an Order. IN WITNESS WHEREOF, the parties have executed this Stipulation for Entry of a Custody Order on the date(s) indicated below. 0.2/1/ (]I Da{e Witness 5;/0/0 ( I I Date ~.~ ~~~ Witn s r~ T: Y L. Me ICHAE -r~, r'~0::> //jt7-<f1.- ,r~'if /CJ1 -t<.z. ~("I?;o~ c4 1/,,;/101;;;- -f/t'"'-~~ Iv . /1 r<!,dA l' A'4Ns:p.--f;;rQ... 0<- t.iJ;1; .4 .P.(A --r:; ..k. . ..1./ .L IIj)'tLo...-{ vll-,^, '7i.: p}.J" " 7/~,[J",>~,..h<~VUIT'" Ii /?J I/'Io,,/I'v I If"" ;P4"''J - t!W'(/?..#. -1-4.. ,NL.,.f,.J / (7 A~~T.5.(Ol>14. -t:4.. mft.."" /J'Iot...v;,;;Jl.u rrwu .~)IA,/t~~. a.r: A01Jl;)~ ~ -rT/.i!JJJ /0 m ,/<IS: ~ 'C_<: '(1S"~~ >4t'/~J tv. t>?A~ d sf" / ~ > I' 01,. <1./..1[/&4- , ,/U~;, c/OC""""..",r,-,'// b_~ J ,~ ;/ -/41 /l~lm,-I9'IIU#"''''/;; /""'''''''''5!:V~ , ..""'", 4,,,, ,...., .e-rn'c7: ~ h1aIA.... 0'1'.J / ;e~S:FI<'S' (4 ~ -1Y(A~'h1 /T.,:, 1) ~ l.~,kI........~ /...; -r,,~..., De<:O'"'"" ~ J FILE/J'!)':Clnf Or: tE P;c'iidNbTAF/Y 0/ ~W?20 PN12:47 CUM[]ffiLA/. 'U- n(,U." "", P~^' ' ,~v 'V'T c;, vNSYLVA!V/A I I I ~ ~ I ~ I .~ I I ~ I . ~ "'-' -. TRACY L. McMICHAEL, Plaintiff v. WILLIAM C. McMICHAEL, Defendant ". ~ =. ".~ " < L J APR 0 2 2001 bP : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY,PENNSYLV ANIA : NO. 2001-652 CIVIL TERM : CIVIL ACTION - LAW : IN CUSTODY ORDER OF COURT AND NOW, this 2ND day of April, 2001, the Conciliator being notified that the parties have signed a Custody Stipulation in the above matter, the Conciliator hereby relinquishes jurisdiction in this matter. FOR THE COURT, tody Conciliator """". , "",,'~.," ';i <"~' .- ~ ~ ~".~~" ....., ~~= --^ -~- ~~<-- i I>"~~""'" ".~. "~~I~ ~_."=.. "'" 'I"" ' ~ 1 I I"~ ",' " -,- l ~-" I -. j \ . ?: 2: :21 C' l'IF,q,i ""i,) il':: ,", '-IY U)~',"-,,-, It...! \: 'Ie,. ,,"-.J,)I\: PENNSYLVAr~IA ilMrill'f!l~~~~~~~~~~",,~~_~1~~....."!""'f""':':,:....:..~::::~~: HIOS.157 REV 1-80 COWMONWeAlJ'H Of' PENNSYlw.N1A DEPARTMENT OF HEAUH VITAL RECORDS 01-&>5;<" <:,.',I,ril STATE FILE NUMBER (tJ;d~/)/YIA " RECORD OF OR ANNULMENT (CHECK ONE) 0 STATE FILE DATE HUSBAND (Middle) h a;'" 0, DATE ~1hJ (Oa,) "'O' He HI OF -3- /q5 BIRTH PA~ 4, PLACE (Sla'. or Fonrlgrl Coun'ryJ OF 81R1H 7. USUAL OCCUPATION ,. NAME --LtliJJ i ()jyJ i~R~'OENCE M i h h itl"'t' ~h 0Jil ry. ~r'p, 5. NUMBER 6. RACE OF B'US WH MARRIAGE (-0 6. OTHEA (Specify) o WIFE /M_) N ( H; c.hJ:i .. :.~ County l St.,. 11. PlACE . 0 pA 81~TH ,... uSUAL QC(:UPATION ~ luK i hfe.r il- J 10 ~'}J q to~- p A (SIa,. or Foreign Counll'y) BLACK o OTHER (Specify) o 15. PLACE OF (eN") THIS f\ MARR'AGE e Ovh r 17A. NUMBER OF 178. NUMBER OF DEPENOENT CHILDREN THIS 1 CH!lo.:9REN UNDER 18 MARRIAGE.:J :;J 20. NUMBER OF HUSBAND CHILDREN 10 0 CUSTODY OF (S"'. or Foreign Counlr)'} 22. DATE OF DECREE (Manlh) 18. PLAINTIFF HUSBAND o 18, DATE OF (Monrh) (Oa,) &eO' THIS .1-15- /q& MARRIAGE 1.. DECREE GRANTED 10 OTHER I_I)! HUSBAND WIFE OTHERI_Iy) 0 0 0 21. LEGAL GROUNDS FOR {c j DIVORCE OR ANNULMENT 3301 03. DATE REPORT SENT (Monrh) (Da)'} (~atJ 10 VITAL RECORDS SPLIT CUStODY o (Day} (ltNItJ 24. SIGNATlIAE OF TRANSCRIBING CLERK w'rte ~lA3 bMcl 55 it ss1F Ittg-b)- 4:J-'3d-., I q q" D"O- 3 b 2 3