[Sections 47-8-30, 47-8-41 to 47-8-43, 47-8-46 NMSA 1978]

STATE OF NEW MEXICO
___________________ COURT
___________________ COUNTY

__________________________________, Plaintiff

v.

__________________________________, Defendant

1.    Defendant is not in default because: ________________
    ____________________________________________________.

2.    The amount of rent that the plaintiff states is owed is not correct because: ________________________________
    ____________________________________________________.

3.    The damages claimed by the plaintiff are not owed to the plaintiff because: ______________________________
    ____________________________________________________.

4.    The defendant asserts the following counterclaim or setoff against the plaintiff:________________________
    ____________________________________________________.

(check if applicable)]
5.    [ ]    Defendant requests separate trials on the issues of restitution and damages.

                ________________________________
                 Signed

                ________________________________
                Name (print)

                ________________________________
                Address (print)

                ________________________________
                City, state and zip code (print)

                ________________________________
                Telephone number

[Adopted effective September 2, 1997.]