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In<SrrWien t N&F'cu <br />201400723445 OR =5 <br />NOTE; In accordance with Chapter 445, Session Lang of Colorado 1967, <br />the Clerk of the District Court is required to furmish certain infor- <br />wation to the Regtstrar of Vital Statiatios. It will, therefore, be <br />neceaaary that the following information be completed by the attorney <br />for the plaintiff and attached to each complaint for Pivorce, Separate <br />Maintenance or Annulment, <br />IN THE: DISTRICT COURT IN AND FOR <br />THE CM= OF US ANIKAS, STATg OF 0OL0800 <br />CIVIL ACTION NO. 21806^ <br />CAROL M. HEALEY <br />Plaint ff <br />Va. <br />BUDDY TACK HEALEY <br />Defendant <br />1. Age o° husband at last birthday 3- <br />2. Age of wife at last birthday. <br />3. Residence of plaintiff - County Las AnZaA <br />state Colorado <br />4. Residence of defendant - County Las Animas <br />State Colorado <br />S. Number of full years married 7 -- <br />6. Number of children under 18 none <br />t <br />Atto ay four Plaintiff <br />