[2-201, 3-201]

STATE OF NEW MEXICO

IN THE ________________ COURT             No. __________
_______________________ COUNTY

____________________________________, Plaintiff

against

____________________________________, Defendant

_____________________________________, Address

_____________________________________, City

    1.    Plaintiff or defendant resides, or may be found in, or the cause of action arose in this county.

    2.    Plaintiff claims from Defendant the amount of $________________ and also claims interest and court costs.

    Plaintiff claims from Defendant personal property of the value of $ _______________, which is described as follows: ______________________________________________________________
______________________________________________________________

    3.    Plaintiff's claim arises from the following event or transaction: __________________________________________________
_______________________________________________________________

    4.    Trial by jury is (not) demanded. (If a jury is demanded, an additional cost must be paid upon filing.)

________________________     _______________________________
Date                        Signed

                        _______________________________
                        Name (print)

                        _______________________________
                        Address (print)

                        _______________________________
                        City, State and Zip Code (print)

                        _______________________________
                        Telephone Number

[As amended, effective January 1, 1995.]