STATE OF NEW MEXICO COUNTY OF McKINLEY ELEVENTH JUDICIAL DISTRICT _____________________________________, Petitioner, -vs_____________________________________, No. D-1113-DM-_______________ Respondent. CERTIFICATE OF CHILD CUSTODY ISSUES I, __________________________________, Petitioner/Respondent, pro se, hereby certify that child custody is at issue in this case. Petitioner’s address and telephone number are: ____________________________________________ Mailing Address ____________________________________________ City/State/Zip ____________________________________________ Telephone: _________________________________ Respondent’s address and telephone number are: Mailing Address ____________________________________________ City/State/Zip ____________________________________________ Telephone: _________________________________ CERTIFICATE OF SERVICE I hereby certify that true and correct copy of the foregoing was mailed to opposing party/counsel this ___ day of _________, 20___. ____________________________________ Petitioner/Respondent signature ____________________________________ Printed name Address: ____________________________ ____________________________________ _____________________________ Signature May 10 rev American LegalNet, Inc. www.FormsWorkFlow.com May 10 rev American LegalNet, Inc. www.FormsWorkFlow.com