4-102

[2-105, 3-105]

STATE OF NEW MEXICO
IN THE ______________ COURT                     No _________
_____________________ COUNTY

IN THE ___________ COURT

____________________________________, Plaintiff

against

____________________________________, Defendant

CERTIFICATE OF EXCUSAL OR RECUSAL

    I hereby certify that I have (been excused) (recused myself) from presiding in the above case and ten (10) days have passed since the parties were notified of such recusal or excusal.

    The parties have not filed a stipulation agreeing to another judge of the district to hear the case.

    It is requested that another judge be designated according to law.

__________________, 19___.    ____________________________
                         Judge

                        Division ___________________

[As amended, effective May 1, 1986 and September 1, 1989; November 1, 1995.]