Appendix XXVII-B Certification of Notification of Complementary Dispute Resolution Alternatives -- Certification by Self-Represented Litigant _________________________________ Plaintiff, v. SUPERIOR COURT OF NEW JERSEY CHANCERY DIVISION - FAMILY PART ___________________ COUNTY DOCKET NO. FM-___________________ CIVIL ACTION _________________________________ Defendant RULE 5:4-2(h) CERTIFICATION BY SELF-REPRESENTED LITIGANT __________________________, of full age, hereby certifies as follows: 1. I am the Plaintiff Defendant in the above captioned matter. 2. I make this Certification pursuant to New Jersey Court Rule 5:4-2(h). 3. I have read the document entitled “Divorce -- Dispute Resolution Alternatives to Conventional Litigation”. 4. I thus have been informed as to the availability of complementary dispute resolution alternatives to conventional litigation. I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment. _______________________________________ Dated: Note: Adopted as Rules Appendix XXVII-B July 16, 2009 to be effective September 1, 2009. CN: 10889-English American LegalNet, Inc. www.FormsWorkFlow.com