Form 4A-204. Motion for referral to mediation (child custody, timesharing, or visitation) (domestic relations actions).

[For use with Rules 1-124 and 1-125 NMRA] STATE OF NEW MEXICO COUNTY OF _______________ __________________ 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 party’s 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: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________. ____________________________ 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 party’s attorney); or [ ] faxed a copy of this motion to _____________________ (the other party or the other party’s 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