STATE OF NEW MEXICO COUNTY OF BERNALILLO SECOND JUDICIAL DISTRICT , Petitioner, v. No. , Respondent. MOTION FOR REFERRAL TO MEDIATION (CHILD CUSTODY, TIMESHARING, OR VISITATION) (domestic relations actions)1 I, (name of Petitioner or Respondent), request the Court to refer the custody, timesharing, or visitation matters in this case to mediation. 1. The minor children of the parties are: Name Age Year of Birth 2. I have tried to talk to (name of the other party or the other party222s attorney if represented). This is what happened: (You MUST check one of these boxes.) [ ] The other party AGREES with my motion. [ ] The other party DOES NOT AGREE with my motion. [ ] The other party WILL NOT TALK TO ME about my motion. [ ] I CANNOT TALK TO THE OTHER PARTY because there is a protective order between us and the other party does not have a lawyer. [ ] I HAVE NOT TALKED TO THE OTHER PARTY because: . 1 Rev. 12/31/14 American LegalNet, Inc. www.FormsWorkFlow.com Signature of party Name (print) Mailing address (print) City, state, and zip code (print) Telephone number VERIFICATION OF SERVICE I affirm under penalty of perjury under the laws of the State of New Mexico that on (date), I (check the applicable item below and fill in all information) [ ] mailed a copy of this motion by United States mail, postage prepaid, to: Name: Mailing address: City, state, and zip code: ; [ ] delivered a copy of this motion to (the other party or the other party222s attorney); or [ ] faxed a copy of this motion to (the other party or the other party222s attorney) using the following fax number: . The transmission was reported as complete and without error. The time and date of the transmission was (a.m) (p.m) on (date). Signature of party Date of signature 2 Rev. 12/31/14 American LegalNet, Inc. www.FormsWorkFlow.com DO NOT FILE THIS PAGE: FOR PARTY USE ONLY USE NOTE 1. This form may be used anywhere in this state to request the court to refer a matter to mediation regarding child custody, timesharing, or visitation in a domestic relations action. [Approved by Supreme Court Order No. 13-8300-010, effective for all pleadings and papers filed on or after May 31, 2013, in all cases pending or filed on or after May 31, 2013; as amended by Supreme Court Order No. 14-8300-011, effective for all pleadings and papers filed on or after December 31, 2014, in all cases filed or pending on or after December 31, 2014.] American LegalNet, Inc. www.FormsWorkFlow.com