Free Name of Person Filing - Wyoming

Name of Person Filing: Address: City, State, Zip Code: Telephone Number: STATE OF WYOMING COUNTY OF ________________ ) ) ss ) IN THE DISTRICT COURT _______________ JUDICIAL DISTRICT Civil Action Case No. _________________

Petitioner:___________________________, ) ) ) vs. ) ) Respondent:_________________________. )

RESPONSE TO MOTION FOR _________________________________

I am the

Petitioner

Respondent in this action. I am requesting that:

(PLEASE PRINT CLEARLY.)

My reasons are:

Date: Name Address City, State, Zip Code (Area Code) Telephone Number (home and work)
CSMod 22 Response to Motion for _________________ Revised July 2006 Page 1 of 2

CERTIFICATE OF SERVICE I certify that on (date) the original of this document was filed with

the Clerk of District Court; and, a true and accurate copy of this document was served on the other party by Hand Delivery OR Faxed to this number OR by placing it in the

United States mail, postage pre-paid, and addressed to the following:

TO: ______________________________________ ______________________________________ ______________________________________

(Your signature)

Print name

CSMod 22 Response to Motion for ________________________ Revised 08/05 Page 2 of 2